Low-Value Diagnostic Imaging in Children with Medicaid.

Objectives To estimate rates and settings of low-value imaging among pediatric Medicaid beneficiaries, and estimate associated expenditures. Study design Retrospective longitudinal cohort study from 2014-2016 of children Results Of the 640,450 encounters for the 5 conditions, there were 36,262 (5.7%) low-value imaging services. Per 1000 encounters, there were 246.0 x-rays for bronchiolitis, 174.0 head computed tomography (CT) studies for minor head trauma, 142.0 and 33.3 neuroimaging studies for headache and simple febrile seizure, respectively, and 19.5 abdominal CTs (without prior US) for abdominal pain. In adjusted analysis, White children were more likely to receive CT for abdominal pain, and Black children were more likely to have imaging for bronchiolitis and minor head trauma; children living in rural areas were more likely to receive imaging for all conditions. Up to 87.9% (CT for minor head trauma) of low-value imaging was in the emergency department (ED), with most imaging across all conditions occurring in non-pediatric EDs; up to 43.7% was in the outpatient setting (neuroimaging for headache); and, up to 20.7% was during inpatient encounters (neuroimaging for febrile seizure). Outpatient and ED low-value imaging resulted in >$7 million in Medicaid expenditures. Conclusion Among the studied conditions, more than one in 20 encounters included low-value imaging, mostly in non-pediatric EDs and for bronchiolitis, head trauma, and headache. Interventions are needed to reduce future performance of these low-value services.