Effectiveness of Pediatric Concurrent Hospice Care to Improve Continuity of Care

Area of Science:

• Pediatric Palliative Care
• Health Services Research
• End-of-Life Care Policy

Background:

• The Patient Protection and Affordable Care Act (ACA) of 2010 introduced significant hospice care legislation for terminally ill children.
• The impact of concurrent pediatric hospice care on end-of-life care continuity remains understudied.

Purpose of the Study:

• To investigate the effect of pediatric concurrent hospice care versus standard hospice care on end-of-life care continuity.
• To analyze outcomes among Medicaid beneficiaries receiving pediatric hospice services.

Main Methods:

• A quasi-experimental study design was employed using national Medicaid data.
• Care continuity was assessed through hospice length of stay, disenrollment, and transitions to emergency or inpatient care using claims data.
• Instrumental variable analysis was utilized to compare the effectiveness of concurrent versus standard hospice care.

Main Results:

• Concurrent hospice care was associated with significantly longer lengths of stay in hospice (β = 2.76, P < .001).
• Concurrent care led to a reduction in hospice live discharges compared to standard care (β = -2.80, P < .05).
• Concurrent care did not significantly reduce transitions to emergency room (β = 2.09, P < .001) or inpatient care (β = .007, P < .05).

Conclusions:

• Concurrent hospice care demonstrates potential benefits for end-of-life care continuity in children.
• Findings highlight the need for policy considerations regarding pediatric end-of-life care quality.
• Further investigation is warranted to address transitions to acute care settings within concurrent hospice models.