<scp>Low‐value</scp> care in pediatric populations: There is no silver lining

Gutman, Colleen K.; Holmes, Sherita; Balhara, Kamna S.

doi:10.1111/acem.14470

Cited by 5 publications

(10 citation statements)

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“…However, as Black and Hispanic children have higher rates of disease complications and death in the health care system, the suggestion of racial disparities in care remains alarming. Any systematic difference in the way care is provided suggests bias may play a role and can also affect unmeasured aspects of care . Given the limitations of assigning import to these secondary outcomes in the setting of multiple testing, more research is needed to understand the full extent of these findings.…”

Section: Discussionmentioning

confidence: 99%

“…Any systematic difference in the way care is provided suggests bias may play a role and can also affect unmeasured aspects of care. 56 Given the limitations of assigning import to these secondary outcomes in the setting of multiple testing, more research is needed to understand the full extent of these findings. Our overall findings may suggest that applying objective risk stratification algorithms reduces the effect of implicit racial biases.…”

Section: Figure Inclusion and Exclusion Flow Diagrammentioning

confidence: 99%

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Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants

Gutman,

Aronson,

Singh

et al. 2024

JAMA Pediatr

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ImportanceFebrile infants at low risk of invasive bacterial infections are unlikely to benefit from lumbar puncture, antibiotics, or hospitalization, yet these are commonly performed. It is not known if there are differences in management by race, ethnicity, or language.ObjectiveTo investigate associations between race, ethnicity, and language and additional interventions (lumbar puncture, empirical antibiotics, and hospitalization) in well-appearing febrile infants at low risk of invasive bacterial infection.Design, Setting, and ParticipantsThis was a multicenter retrospective cross-sectional analysis of infants receiving emergency department care between January 1, 2018, and December 31, 2019. Data were analyzed from December 2022 to July 2023. Pediatric emergency departments were determined through the Pediatric Emergency Medicine Collaborative Research Committee. Well-appearing febrile infants aged 29 to 60 days at low risk of invasive bacterial infection based on blood and urine testing were included. Data were available for 9847 infants, and 4042 were included following exclusions for ill appearance, medical history, and diagnosis of a focal infectious source.ExposuresInfant race and ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White, and other race or ethnicity) and language used for medical care (English and language other than English).Main Outcomes and MeasuresThe primary outcome was receipt of at least 1 of lumbar puncture, empirical antibiotics, or hospitalization. We performed bivariate and multivariable logistic regression with sum contrasts for comparisons. Individual components were assessed as secondary outcomes.ResultsAcross 34 sites, 4042 infants (median [IQR] age, 45 [38-53] days; 1561 [44.4% of the 3516 without missing sex] female; 612 [15.1%] non-Hispanic Black, 1054 [26.1%] Hispanic, 1741 [43.1%] non-Hispanic White, and 352 [9.1%] other race or ethnicity; 3555 [88.0%] English and 463 [12.0%] language other than English) met inclusion criteria. The primary outcome occurred in 969 infants (24%). Race and ethnicity were not associated with the primary composite outcome. Compared to the grand mean, infants of families that use a language other than English had higher odds of the primary outcome (adjusted odds ratio [aOR]; 1.16; 95% CI, 1.01-1.33). In secondary analyses, Hispanic infants, compared to the grand mean, had lower odds of hospital admission (aOR, 0.76; 95% CI, 0.63-0.93). Compared to the grand mean, infants of families that use a language other than English had higher odds of hospital admission (aOR, 1.08; 95% CI, 1.08-1.46).Conclusions and RelevanceAmong low-risk febrile infants, language used for medical care was associated with the use of at least 1 nonindicated intervention, but race and ethnicity were not. Secondary analyses highlight the complex intersectionality of race, ethnicity, language, and health inequity. As inequitable care may be influenced by communication barriers, new guidelines that emphasize patient-centered communication may create disparities if not implemented with specific attention to equity.

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Section: Discussionmentioning

confidence: 99%

Section: Figure Inclusion and Exclusion Flow Diagrammentioning

confidence: 99%

Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants

Gutman,

Aronson,

Singh

et al. 2024

JAMA Pediatr

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“…Some research suggests that patients with more access to healthcare have a higher likelihood of receiving unnecessary interventions 9,10 . However, as literature on this topic evolves, it is becoming clear that relationships between low‐value care delivery and social influences of health are mixed and complex 4,9,11 . For example, Black and Hispanic patients, who have been demonstrated to receive less evidence‐based care for some conditions than White patients, are also more likely to receive selected low‐value services compared to White patients 1 .…”

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confidence: 99%

Improving healthcare value: The need to explicitly address equity in high‐value care

Liang,

House,

Moriates

2024

Journal of Hospital Medicine

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“…These findings add to an upsetting body of literature demonstrating that, throughout health care, Black children have disproportionately high rates of death. Black children are more likely than children of other races to die of sepsis, sudden cardiac arrest, congenital heart disease, and cancer, as well as after routine outpatient surgery . Although long-standing structural racism has led to Black children having elevated disease burden and risk of health-related social need, this does not sufficiently explain the inequitably high mortality rate.…”

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confidence: 99%

“…Black children are less likely to receive antibiotics, intravenous hydration, and adequate pain medication. Additionally, they are less likely to be recognized as having severe infections, including appendicitis and sepsis . Such differences in treatment likely represent only a subset of the inequitable care decisions and processes that lead to differential rates of child death.…”

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confidence: 99%

Emergency Department Pediatric Readiness and the Search for Solutions That Promote Child Health Equity

Gutman,

Hall,

Lion

2023

JAMA Netw Open

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In JAMA Network Open, Jenkins et al 1 report alarming racial disparities in in-hospital mortality among children presenting to the emergency department (ED) for acute medical illnesses. In a sample of 633 536 children treated at 1 of 586 EDs across 11 states between 2012 and 2017, Black children with acute medical illness had higher adjusted odds of death compared with the overall sample mean.These findings add to an upsetting body of literature demonstrating that, throughout health care, Black children have disproportionately high rates of death. Black children are more likely than children of other races to die of sepsis, sudden cardiac arrest, congenital heart disease, and cancer, as well as after routine outpatient surgery. 2 Although long-standing structural racism has led to Black children having elevated disease burden and risk of health-related social need, this does not sufficiently explain the inequitably high mortality rate. Jenkins et al 1 present findings similar to others: racial inequities in child mortality persist when accounting for sociodemographic factors, disease complexity, and illness acuity. With the critical recognition that race and ethnicity are social

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Low‐value care in pediatric populations: There is no silver lining

Cited by 5 publications

References 56 publications

Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants

Race, Ethnicity, Language, and the Treatment of Low-Risk Febrile Infants

Improving healthcare value: The need to explicitly address equity in high‐value care

Emergency Department Pediatric Readiness and the Search for Solutions That Promote Child Health Equity

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