Achievable Benchmarks of Care in Low-Value Care Delivery in Children's Hospitals

Abstract

Objective: Achievable benchmarks of care (ABCs) use performance data to derive objective and attainable targets for improvement initiatives. We applied the Pediatric Health Information System (PHIS) low-value care (LVC) Calculator to describe variation in LVC across hospitals and identify measures with the greatest potential for improvement.

Methods: We applied the 16 LVC Calculator measures applicable to hospitalized patients younger than 18 years old to PHIS hospitalizations from July 1, 2022, to June 30, 2024. We used hospital-level data to assess LVC variation using IQRs and calculate ABCs, defined as the average performance attained by top-performing hospitals. We then compared median hospital-level performance to ABCs to derive measure-level performance gaps, signifying objective improvement potential. Finally, we performed a quartile analysis identifying hospitals with consistently high or low LVC delivery across measures.

Results: A total of 401 683 hospitalizations at 43 children's hospitals were eligible for included measures. LVC delivery varied widely across hospitals for many measures. Ten measures demonstrated performance gaps of greater than 10%; the greatest performance gaps were observed for C-reactive protein and/or erythrocyte sedimentation rate for community-acquired pneumonia (39%), electrolyte testing in patients with febrile seizure (38%), and blood cultures in community-acquired pneumonia (35%). Five measures demonstrated ABCs of less than 5%. Quartile analyses demonstrated small cohorts of hospitals with consistently high or low performance across all measures.

Conclusions: This analysis suggests measurable improvement potential for several low-value services and offers measure-specific deimplementation targets. Further study of high- and low-performing hospitals may identify hospital-level drivers of LVC trends.