# Measuring pediatric hospital-based low-value care: Urban-rural disparities and associated downstream healthcare utilization

> **NIH NIH P20** · DARTMOUTH-HITCHCOCK CLINIC · 2024 · $246,953

## Abstract

Low-value care (LVC), defined as care for which the likely degree of benefit is outweighed by harms or 
costs, is a critical domain of healthcare waste. Efforts to reduce LVC have intensified as literature has 
elucidated the magnitude of associated patient- and system-level harms. In the pediatric hospital setting 
(inclusive of inpatient and emergency departments (ED)), describing the impact of LVC has been identified 
as a research priority. LVC persists for many conditions commonly cared for in this environment despite 
increasing evidence of their ineffectiveness. While a growing body of literature describes the prevalence of 
pediatric hospital-based LVC, research on this topic in the United States (US) to date has focused largely 
on freestanding children’s hospitals, all of which are located in urban regions. Little is known about the 
prevalence and impact of pediatric LVC in rural hospitals, which provide the majority of hospital care for the 
one-in-five US children who reside in rural regions. This is particularly relevant because rural-residing 
children are under-represented in research and have poorer health outcomes and child mortality than their 
urban-residing peers. Additionally, the downstream implications of hospital-based LVC, including health 
outcomes and additional healthcare utilization, have not been well-characterized in children. Our research 
group previously utilized a framework endorsed by the National Quality Forum to develop the Pediatric 
Health Information System (PHIS) LVC Calculator, a tool measuring 30 low-value pediatric inpatient and 
ED services. The current proposal seeks to apply the content and methodology employed by the PHIS LVC 
Calculator to develop and implement a similar tool applicable to Medicaid data from eight states. Through 
application of this tool, we specifically aim to: 1) measure urban-rural disparities in pediatric hospital-based 
LVC delivery and determine if these disparities are moderated by hospital type and setting; 2) characterize 
downstream healthcare utilization (hospital revisits, imaging studies and prescription fills) and Medicaid 
spending associated with LVC delivery; and 3) using qualitative methods, identify deimplementation 
considerations in rural regions from the perspectives of rural hospital stakeholders.

## Key facts

- **NIH application ID:** 11038051
- **Project number:** 5P20GM148278-02
- **Recipient organization:** DARTMOUTH-HITCHCOCK CLINIC
- **Principal Investigator:** Samantha A. House
- **Activity code:** P20 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $246,953
- **Award type:** 5
- **Project period:** 2024-02-15 → 2028-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11038051

## Citation

> US National Institutes of Health, RePORTER application 11038051, Measuring pediatric hospital-based low-value care: Urban-rural disparities and associated downstream healthcare utilization (5P20GM148278-02). Retrieved via AI Analytics 2026-05-29 from https://api.ai-analytics.org/grant/nih/11038051. Licensed CC0.

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