Pediatric Primary Care Involvement in End-of-Life Care for Children

Journal of Palliative Medicine

2017

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Background: Over 42,000 children die each year in the United States, including many with multiple complex chronic conditions (MCCCs), but little is known about whether the presence of MCCCs influences families to utilize pediatric hospice care. Objective: The study objective was to examine the relationship between MCCCs and pediatric hospice utilization among Medicaid beneficiaries. Methods: A retrospective, longitudinal cohort design was conducted with 2007-2010 California Medicaid data to examine the relationship between MCCCs (i.e., two or more MCCCs) and pediatric hospice utilization (i.e., hospice enrollment, hospice length of stay). Multivariate logistic regression with year fixed effects examined the effect of MCCCs on hospice enrollment, and negative binomial model with year fixed effects explored the relationship between MCCCs and hospice length of stay. Results: More than 10% of children enrolled in hospice care with an average length of stay of approximately three days. In the study sample, 48.6% of the children had MCCCs. MCCCs were not significantly related to hospice enrollment. However, children with MCCCs (incidence rate ratios = 4.25, p < 0.01) were associated with an increase in the number of days in hospice care. Conclusions: This study demonstrated that children with MCCCs have limited hospice care utilization at end of life. Future research is needed to explore barriers to hospice care for children with MCCCs.

Section: Methodsmentioning

confidence: 99%

Multiple Complex Chronic Conditions and Pediatric Hospice Utilization among California Medicaid Beneficiaries, 2007–2010

Journal of Palliative Medicine

2017

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“…The first measure of hospice enrollment was defined as whether or not a child was enrolled in hospice care during the last calendar year of life (34,35). This variable was created using data from the MAX Personal Summary Record type of service indicator code 35 for hospice and confirmed in the MAX Other Services Record using revenue codes 651, 652, 655, and 656.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Pediatric Palliative Care Policy on Hospice Utilization Among California Medicaid Beneficiaries

Journal of Pain and Symptom Management

2016

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Background California implemented pediatric palliative care legislations that allowed children to receive curative and supportive care from diagnosis of a life-threatening, serious illness in 2010. Palliative care policies may improve access to hospice care as children near end of life. Objectives To examine the effect of the palliative care policy on hospice utilization for children and their families was investigated. Research Design Using 2007 and 2010 California Medicaid data, a difference-in-difference analysis was conducted to analyze hospice use (i.e., hospice enrollment, hospice length of stay) changes for children who resided in pediatric policy counties relative to those who did not. Population Studied The sample of children in California who died with a life-threatening, serious illness in 2007 and 2010 equaled 979 children. Results Over 10% of children enrolled in hospice care with an average of less than 3 days of hospice care. The palliative care policy did not have any effect on hospice enrollment. However, the policy was positively associated with increasing days in hospice care (IRR= 5.61, p<0.05). The rate of hospice length of stay increased by a factor of 5.61 for children in palliative care counties, compared to children unaffected by the policy. Conclusions The pediatric palliative care policy was associated with longer lengths of stay in hospice once the children were enrolled. Policies promoting palliative care are critical to ensuring access to hospice care for children.

“…21,22 Preliminary work in this area suggests that, compared to other pediatric age groups, adolescents are most influenced by their relationship with a primary care provider. 23 However, a major concern among adolescents is aging out of service with their usual source of primary care. Many pediatricians, for example, require adolescents to find a family practice or internal medicine provider once they reach 18 or 19 years of age, which often disrupts the trusted relationship that has formed between the adolescent and provider over the youth’s lifetime.…”

Section: Introductionmentioning

confidence: 99%

End-of-Life Transitions and Hospice Utilization for Adolescents

Keim‐Malpass

2017

J Hosp Palliat Nurs

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Adolescents with life-limiting illnesses have intensive end-of-life trajectories and could benefit from initiation of hospice services. The medical home model, which includes having a usual source of primary care, may help facilitate quality outcomes at the end-of-life for adolescents. The purpose of this study was to determine the relationship between having a usual source of primary care on hospice utilization and end-of-life transitions among adolescents between 15–20 years with a life-limiting illness. A retrospective cohort design used 2007–2010 California Medicaid claims data (n=585). Our dependent variables were hospice utilization (i.e., hospice enrollment, hospice length of stay) and the independent variable was usual source of primary care. Multivariate regression techniques including least squares regression, multivariate logistic regression, and negative binomial regression were used in the analysis of the relationship between usual source of primary care and hospice utilization and end-of-life transitions. Ten percent of our sample utilized hospice services. Having a usual source of primary care was associated with an increase in hospice enrollment, hospice length of stay, and end-of-life transitions. Adolescents with a cancer diagnosis were more likely to enroll in hospice services. For adolescents at the end of life, having a usual source of primary care had a significant impact on hospice enrollment and length of stay. This study is among the first to demonstrate a relationship between primary care and hospice use among this vulnerable population.