Adherence to "Choosing Wisely" Recommendations in Pediatric Emergency Medicine

Abstract

Study objective: In 2022, Choosing Wisely released recommendations to decrease the frequency of low-value testing in pediatric emergency medicine. The extent to which low-value testing occurs in US emergency departments (EDs) may vary by ED experience. We compared the frequency of low-value testing with ED volume.

Methods: We conducted a cross-sectional study using data from the Healthcare Cost and Utilization Project in all EDs in 8 states from January 1, 2014 to December 31, 2020. We included children aged below 18 years with one of the addressed diagnoses: respiratory tract illness, mental or behavioral health condition, seizure, constipation, or respiratory viral illness. ED volume was defined using National Pediatric Readiness Program categories of pediatric visits per year: less than 1,800 (low); 1,800 to 4,999 (low-medium); 5,000 to 9,999 (medium); or ≥10,000 (high) with an outcome of low-value testing, determined using procedure codes. We evaluated the adjusted association of volume with low-value testing using logistic regression with clustering by site.

Results: We analyzed 5.6 million visits. Low-value tests were obtained in 19.3% of encounters. Low-value tests were obtained in 12.2% of visits to low-volume EDs, 20.5% for low-medium-volume EDs, 23.1% for medium-volume EDs, and 18.7% for high-volume EDs. Low-volume sites had the lowest rates of testing for mental or behavioral health conditions, constipation, and respiratory viral illness. High-volume sites had the lowest rates of testing for respiratory tract illness and seizure.

Conclusions: Low-value testing occurred in one fifth of ED visits for children with a study condition. The relationship of ED volume to low-value testing was inconsistent across conditions.

Keywords: Choosing Wisely; Low-value care; Low-value testing; Pediatric emergency medicine.