Pediatric Palliative Care: Describing Hospice Users and Identifying Factors that Affect Hospice Expenditures

Presenter: Caprice Knapp, University of Florida

Abstract

Objective: Each year approximately 50,000 children die. These children could benefit from pediatric palliative care and hospice is one important provider of palliative care. However, little information exists to understand the prevalence of pediatric hospice use, the factors associated with using pediatric hospice care, and the expenditure patterns of pediatric hospice users. This study aims to describe pediatric hospice and non-hospice users and to identify factors that affect hospice expenditures. Information from this study can be used to develop and refine pediatric palliative care programs as well as interventions aimed at reducing disparities in pediatric helath care at the end of life.

Design: Retrospective, cross-sectional analyses of matched administrative and death certificate data. Descriptive analyses were used to describe the prevalence of pediatric hospice use and test the differences in mean inpatient, outpatient, and emergency department expenditures for hospice and non-hospice users. Two-part multivariate models were used to estmate the relationship between several confounders (child's age, gender, race, urbanicity, and months enrolled in Medicaid) and hospice expenditures.

Participants: 1,527 children enrolled in Florida's Medicaid program aged 12 months to 21 years.

Results: Few children in the sample used hospice services (11%) and their dominant location of death was home (55%). Descriptive analyses show that pediatric hospice users had higher inpatient, outpatient, emergency department, and pharmacy expenditures than non-hospice users. Two-part, multivariate regression results show that Black non-Hispanic, Hispanic, and children of other races had $730 to $880 fewer hospice expenditures than Whites, suggesting that they receive about 6 to 7 fewer days of routine hospice care. Higher hospice expenditures ($970) were also associated with longer enrollment spans.

Conclusions: Descriptive analyses suggest that there are differences between pediatric hospice and non-hospice users. Minority race/ethnicities, as well as shortened Medicaid enrollment spans, are both associated with decreased hospice expenditures. Information from this study can be used to develop interventions aimed at increasing the prevalence of and reducing inequalities in hospice care.