Low‐value care and variation in practice in the care of children hospitalized with bronchiolitis in Canada (CareBEST): Protocol for a multi‐center prospective cohort study
Bibliographic record
Abstract
INTRODUCTION: Low-value care refers to health services for which the potential harms or costs outweigh the benefits of use. Bronchiolitis is the most common and among the most costly causes of pediatric hospitalizations. Evidence consistently shows that many common tests and treatments used to manage bronchiolitis do not improve outcomes. Further, differential use of low-value care between patients may perpetuate care inequities. In Canada, rates of low-value care use in children hospitalized with bronchiolitis, and differences in care across hospitals, clinicians, and patient subgroups, remain poorly characterized. OBJECTIVE: To understand practice patterns for six low-value health services in the care of children aged 1-12 months hospitalized for bronchiolitis: respiratory virus testing; chest X-rays; continuous pulse oximetry; short-acting beta-agonists; systemic corticosteroids; and antibiotics. METHODS: We are conducting a multi-center prospective cohort study of children admitted with bronchiolitis in 15 Canadian hospitals. We will use chart reviews to compare low-value care use between hospitals and clinicians, and caregiver surveys to compare between sociodemographic groups. Questionnaires will also collect caregiver perspectives on their child's bronchiolitis care, including role in medical decision-making and understanding of treatment decisions. DISCUSSION: Our study will provide critical information on the usage and variation in delivery of low-value care for bronchiolitis in Canada, elucidating potential care inequities. Findings will inform the development of interventions to address such inequities, and improve opportunity costs for health systems. Enrollment began in October 2024 and is projected to be completed in May 2026, with analyses and reporting shortly following.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.039 | 0.033 |
| Meta-epidemiology (narrow) | 0.004 | 0.003 |
| Meta-epidemiology (broad) | 0.005 | 0.008 |
| Bibliometrics | 0.005 | 0.009 |
| Science and technology studies | 0.008 | 0.003 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.019 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".