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Length of Stay by Pediatric Hospice Diagnoses: A Retrospective Experience from a Single Center
Emily Sierakowski1, Claudia Delgado Corcoran2, Dominic Moore2
1Intermountain Healthcare (E.S., J.M.), Salt Lake City, UT.
Insights
Pediatric hospice care utilization shows concurrent care hospice leads to longer stays. Short stays and late referrals remain challenges in pediatric end-of-life care.
Area of Science:
- Pediatric Palliative Care
- Hospice and Palliative Medicine
- Healthcare Utilization Research
Background:
- Pediatric hospice offers critical care for children with terminal illnesses, typically with a prognosis of six months or less.
- Limited data exists on hospice utilization patterns across various pediatric diagnoses.
- Understanding these trends is crucial for optimizing end-of-life care for children.
Purpose of the Study:
- To conduct a retrospective analysis of pediatric hospice patients.
- To describe clinical trends and hospice utilization based on different diagnoses.
- To identify factors influencing length of stay in pediatric hospice.
Main Methods:
- A single-center retrospective study of pediatric hospice patients (0-23 years) from 2015-2023.
- Descriptive statistics were used to analyze hospice diagnoses, length of stay (LOS), and care type (traditional vs. concurrent).
- Patients were categorized into oncologic, neurologic, genetic/metabolic, and cardiovascular diagnostic groups.
Main Results:
- Concurrent care hospice patients had significantly longer median LOS (33 days) than traditional hospice (14 days).
- Over half of the children (58%) had hospice stays under one month, with 20% experiencing late referrals (LOS ≤ 3 days).
- No statistically significant differences in LOS were found across the four main diagnostic categories.
Conclusions:
- Concurrent care models are associated with longer pediatric hospice stays.
- Short hospice lengths of stay and late referrals persist, indicating areas for improved access and timely enrollment.
- Hospice LOS did not vary significantly by primary diagnosis in this cohort.
Context:
Pediatric hospice provides care for children during the final stages of a terminal illness, usually defined as a prognosis of six months or less. There is limited data to inform hospice utilization in children among different hospice diagnoses.
Objective:
The objective of this study is to perform a retrospective analysis of pediatric hospice patients to better describe clinical trends and utilization among different hospice diagnoses.
Methods:
This is a single center retrospective study of pediatric hospice patients enrolled in hospice from 2015-2023 (0-23 y). Using descriptive statistics, the study examines hospice diagnoses, hospice length of stay (LOS), and the type of hospice care, traditional or concurrent care hospice.
Results:
One hundred fifty-five pediatric hospice patients met criteria. Children were divided into the four most common diagnostic categories: oncologic (n = 54), neurologic (n = 41), genetic/metabolic (n = 38), and cardiovascular (n = 22). Children who received concurrent care hospice had significantly longer median hospice LOS compared to traditional hospice care (33d vs. 14d; P < 0.001). More than half of the children spent less than one month in hospice (90/155, 58%) with 20% having a late referral defined as hospice LOS ≤ 3 days. There were no statistically significant results between LOS in the four most common diagnostic categories.
Conclusion:
Hospice LOS was not statistically different across diagnostic categories. Children enrolled in concurrent care hospice have statistically significant longer stays in hospice compared to traditional hospice. Short hospice stays and late referrals continue to occur.
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