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Pediatric Palliative Care Program versus Usual Care and Healthcare Resource Utilization in British Columbia: A
Tania Conte1,2, Craig Mitton1,2, Shannon Erdelyi1
11 Centre for Clinical Epidemiology and Evaluation, University of British Columbia , Vancouver, British Columbia, Canada .
Insights
Pediatric palliative care programs (PPCP) show increased critical care admissions but shift inpatient use to hospice. Further research is needed to understand resource utilization in pediatric end-of-life care.
Area of Science:
- Healthcare Management
- Pediatrics
- Palliative Care
Background:
- Limited evidence exists on pediatric palliative care programs' (PPCP) resource utilization beyond hospitals.
- Broader measures are needed to assess the full impact of PPCP on healthcare resource use.
Purpose of the Study:
- To conduct a Canadian comparative analysis of resource utilization in children enrolled in PPCP versus those receiving usual care.
- To include hospice use in the measurement of inpatient resource utilization.
Main Methods:
- Retrospective matched-pairs cohort study comparing children who died in hospice versus hospital (2008-2012).
- Data sourced from administrative databases and chart reviews.
- Key outcomes: number of admissions and length of stay (LOS).
Main Results:
- No significant difference in total admissions between PPCP users and usual care, but PPCP users had increased admissions post-referral due to critical care needs.
- No significant difference in LOS, but PPCP users had longer admissions pre- and post-referral.
- Over 60% of inpatient utilization shifted to hospice post-referral for PPCP users.
Conclusions:
- Children referred to PPCP may have higher pre-enrollment critical care needs.
- A substantial shift in inpatient utilization to hospice settings was observed post-referral.
- Findings suggest implications for resource reallocation and optimizing PPCP referrals.
Background:
Evidence on the impact of pediatric palliative care programs (PPCP) on resource utilization is scarce and requires broader measures to include utilization beyond the hospital setting.
Objective:
This research aims to provide a Canadian comparative analysis between children in a PPCP with those under usual care, including hospice use to inpatient resource use measurement.
Methods:
We conducted a retrospective matched-pairs (disease and age at death) cohort comparison of children who died in hospice versus hospital (never enrolled in a PPCP), from 2008 to 2012. Utilization was retrieved from administrative databases and chart review. The main outcomes were number of admissions and length of stay (LOS).
Results:
Eleven pairs were found. PPCP users were more likely to have advanced directives (100% vs. 27%). After controlling for disease and age, we found no significant difference in number of admissions; however, PPCP users had an increase in admissions post-referral compared to pre-referral (median 3.08 admissions), driven by the need for critical care. We did not find a significant difference in LOS, but observed longer admissions among PPCP users pre- (1.91 days/month) and post-referral (3.66 days/month) compared to usual care. Over 60% of inpatient utilization shifted to the hospice post-referral.
Discussion:
The terminal pediatric population referred to PPCP may systematically differ from those under usual care even before enrollment, presenting with higher inpatient utilization in critical care nearing death. A significant portion of inpatient utilization shifted to the hospice, with implications for resource reallocation and enhancements in PPCP referrals.
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