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Factors associated with the provision of hospice care for children
Lisa C Lindley1, Barbara A Mark, Shoou-Yih Daniel Lee
1College of Nursing, University of Tennessee, Knoxville, TN 37996, USA. llindley@utk.edu
Insights
Hospices that are members of professional groups are more likely to offer pediatric hospice care. Smaller hospices and those facing increased competition are less likely to provide this vital end-of-life care for children.
Area of Science:
- Healthcare Management
- Pediatric Palliative Care
- Health Services Research
Background:
- Children at the end of life often have limited access to specialized hospice care.
- Factors influencing hospice provision of pediatric services are not well understood.
Purpose of the Study:
- To identify institutional and resource factors linked to the provision of pediatric hospice care.
- To understand how organizational characteristics affect the availability of end-of-life care for children.
Main Methods:
- Retrospective, longitudinal study using California hospice data (2002-2008).
- Generalized estimating equations applied to 311 hospices (1368 observations).
- Examined institutional and resource dependence theories to analyze factors influencing pediatric care provision.
Main Results:
- Professional group membership increased the likelihood of offering pediatric hospice care by 19%.
- Smaller hospices (small: -22%, medium: -11%) and those in competitive markets (-23%) were less likely to provide pediatric care.
- Organizational size moderated the impact of accreditation and professional membership on care provision.
Conclusions:
- Professional group membership may encourage adherence to pediatric care standards.
- Hospices, particularly medium-sized ones, can enhance pediatric care by engaging with professional organizations.
- Identifying a 'pediatric champion' within professional groups can facilitate the development of pediatric hospice services.
Context:
Children at the end of life often lack access to hospice care at home or in a dedicated facility. The factors that may influence whether or not hospices provide pediatric care are relatively unknown.
Objectives:
The purpose of this study was to understand the institutional and resource factors associated with provision of pediatric hospice care.
Methods:
This study used a retrospective, longitudinal design. The main data source was the 2002 to 2008 California State Hospice Utilization Data Files. The sample size was 311 hospices or 1368 hospice observations over seven years. Drawing on institutional and resource dependence theory, this study used generalized estimating equations to examine the institutional and resource factors associated with provision of pediatric hospice care. Interaction terms were included to assess the moderating effect of resource factors on the relationship between institutional factors and provision of care.
Results:
Membership in professional groups increased the probability (19%) of offering hospice services for children. Small- (-22%) and medium-sized (-11%) hospices were less likely to provide care for children. The probability of providing pediatric hospice care diminished (-23%) when competition increased in the prior year. Additionally, small size attenuated the accreditation-provision relationship and medium size magnified the membership-provision relationship.
Conclusion:
Professional membership may promote conformity to industry standards of pediatric care and remove the unknowns of providing hospice care for children. Hospices, especially medium-sized hospices, interested in developing or expanding care for children may benefit by identifying a pediatric champion to join a professional group.
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