{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:52:27Z","timestamp":1790185947308,"version":"4.1.0"},"reference-count":31,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>To examine (1) differences in low-value care (LVC) for common emergency conditions by race and ethnicity in US children\u2019s hospitals and (2) the association between hospital characteristics, including LVC rate, and the magnitude of within-hospital LVC differences by race and ethnicity. We hypothesized smaller LVC differences in hospitals with lower overall LVC rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We performed a cross-sectional study of children younger than 18\u00a0years discharged from the emergency department with asthma, bronchiolitis, headache, or minor head injury in the Pediatric Health Information System (PHIS) from January 2021 to June 2023. Exposures were patient race and ethnicity (non-Hispanic Black, \u201cBlack\u201d; non-Hispanic white, \u201cwhite\u201d; Hispanic) and deidentified PHIS hospital. Outcomes were LVC by race and ethnicity within and across hospitals. We used multivariable logistic regression, reporting adjusted odds ratios (aORs) and 95% CI, to estimate hospital-level and condition-specific LVC differences and linear regression to examine the association between LVC differences and LVC rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 314\u2009138 eligible encounters, overall LVC rates were as follows: asthma 18%, bronchiolitis 32%, headache 24%, and minor head injury 26%. White compared with Black and Hispanic patients had higher odds of LVC across multiple conditions in pooled and within-hospital analyses. The largest pooled differences were for white vs Black: asthma aOR (95% CI)\u2009=\u20091.51 (1.18\u20131.95) and headache 1.57 (1.43\u20131.72). Hospital LVC rate was not associated with magnitude of within-hospital LVC difference for any condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Lower hospital LVC rates were not associated with reduced LVC differences. Intentional focus on LVC differences is important when designing LVC reduction efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2025-072242","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:02:57Z","timestamp":1771286577000},"source":"Crossref","is-referenced-by-count":1,"title":["Low-Value Emergency Care and Racial and Ethnic Differences Across US Children\u2019s Hospitals"],"prefix":"10.1542","volume":"157","author":[{"given":"Robert H.","family":"Rosen","sequence":"first","affiliation":[{"name":"1Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, New York"},{"name":"2Department of Pediatrics, New York University Grossman School of Medicine, New York University Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"Porter","sequence":"additional","affiliation":[{"name":"3Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Monuteaux","sequence":"additional","affiliation":[{"name":"3Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"4Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha A.","family":"House","sequence":"additional","affiliation":[{"name":"5Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce","family":"Li","sequence":"additional","affiliation":[{"name":"3Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"4Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark I.","family":"Neuman","sequence":"additional","affiliation":[{"name":"3Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"4Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Stack","sequence":"additional","affiliation":[{"name":"3Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"4Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara L.","family":"Toomey","sequence":"additional","affiliation":[{"name":"4Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lois K.","family":"Lee","sequence":"additional","affiliation":[{"name":"3Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"4Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"issue":"1","key":"2026030411120531600_r1","doi-asserted-by":"crossref","first-page":"e2023062492","DOI":"10.1542\/peds.2023-062492","article-title":"Trends in low-value care among children\u2019s hospitals","volume":"153","author":"House","year":"2024","journal-title":"Pediatrics."},{"issue":"12","key":"2026030411120531600_r2","doi-asserted-by":"crossref","first-page":"e2135184","DOI":"10.1001\/jamanetworkopen.2021.35184","article-title":"Development and use of a calculator to measure pediatric low-value care delivered in US children\u2019s hospitals","volume":"4","author":"House","year":"2021","journal-title":"JAMA Netw Open."},{"issue":"6","key":"2026030411120531600_r3","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1111\/acem.14468","article-title":"Racial and ethnic differences in low-value pediatric emergency care","volume":"29","author":"Li","year":"2022","journal-title":"Acad Emerg Med."},{"issue":"2","key":"2026030411120531600_r4","doi-asserted-by":"crossref","first-page":"e20191765","DOI":"10.1542\/peds.2019-1765","article-title":"The impact of racism on child and adolescent health","volume":"144","author":"Trent","year":"2019","journal-title":"Pediatrics."},{"issue":"1","key":"2026030411120531600_r5","doi-asserted-by":"crossref","first-page":"e2024066854","DOI":"10.1542\/peds.2024-066854","article-title":"Optimizing advanced imaging of the pediatric patient in the emergency department: policy statement","volume":"154","author":"Marin","year":"2024","journal-title":"Pediatrics."},{"key":"2026030411120531600_r6","article-title":"New Requirements to Reduce Health Care Disparities. 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