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Table 3 Comparison of Low-Value Care in Direct versus Purchased Care

From: Use of low-value pediatric services in the Military Health System

No. Servicea No. Receiving Service in DC No. Receiving Service in PC No. in DC Denominator No. in PC Denominator % of DC in the Denominator Receiving Service % of PC in the Denominator Receiving Service Adjustedb OR (95% CI) for Direct Care
1 Population-based screening for vitamin D deficiency 1605 3189 386,450 306,462 0.42 1.04 0.48 (0.45–0.51)*
2 Skin prick test or IgE blood tests in children with atopic dermatitis 88 29 136 6975 64.71 0.42 3.23 (2.10–4.97)*
3 Testing for RSV in children with bronchiolitis 331 25 1876 2998 17.64 0.83 21.60 (14.29–32.65)*
4 Blood tests in children with a simple febrile seizure 22 2 180 326 12.22 0.61 24.44 (5.49–108.82)*
5 Cervical cancer screening w/ HPV test or Papanicolaou test in children 39 721 39,269 48,531 0.10 1.49 0.07 (0.05–0.09)*
6 Testing for group A streptococcal pharyngitis in children aged < 3 years 3772 4241 65,830 29,065 5.73 14.59 0.36 (0.34–0.38)*
7 Face or nose radiograph in children with head or face trauma 207 219 8892 13,910 2.33 1.57 1.98 (1.62–2.42)*
8 Ultrasound in children with cryptorchidism 45 63 282 310 15.96 20.32 0.68 (0.44–1.06)
9 Sinus imaging in children with acute sinusitis 12 40 3480 20,976 0.34 0.19 1.99 (1.03–3.81)*
10 Neuroimaging in children with a simple febrile seizure 4 5 180 326 2.22 1.53 1.42 (0.37–5.42)
11 Neuroimaging in children with headache 175 997 3084 10,632 5.67 9.38 0.59 (0.50–0.69)*
12 Cough and cold medications in children aged < 6 y
13 Oral antibiotics for acute upper respiratory infections 3235 9830 50,148 54,391 6.45 18.07 0.35 (0.34–0.37)*
14 Oral antibiotics for acute OME 1219 3475 3300 8419 36.94 41.28 0.82 (0.75–0.89)*
15 Oral antibiotics for acute otitis externa 333 589 4069 6092 8.18 9.67 0.82 (0.72–0.95)*
16 Oral antibiotics after tonsillectomy 13 211 677 1815 1.92 11.63 0.14 (0.08–0.25)*
17 Oral antibiotics for bronchiolitis 186 648 1876 2998 9.91 21.61 0.48 (0.40–0.58)*
18 Oral corticosteroids for bronchiolitis 276 684 1876 2998 14.71 22.82 0.62 (0.53–0.72)*
19 Short-acting β-agonists for bronchiolitis 795 1158 1876 2998 42.38 38.63 1.16 (1.03–1.31)*
20 Acid blockers for infants with uncomplicated gastroesophageal reflux
  1. aMeasures and denominator definitions as described by Chua, et al [11]
  2. bLogistic regression models for each measure were adjusted by age and gender
  3. *Statistically significant Adjusted Odds Ratio (AOR) and 95% Confidence Interval (CI), p-value < 0.05
  4. – Data unavailable due to inability to compare direct vs purchased care under defined measure constructs