Pediatric Primary Care Involvement In End-of-life Care For Children

Pediatric Primary Care Involvement In End-of-life Care For Children

Lindley L; Nageswaran Savithri

10.1177/1049909115609589

The American Journal Of Hospice & Palliative Care

2017

Objectives To examine the relationship between pediatric primary care involvement and hospice and home health care use at end of life. Methods California Medicaid data were used to estimate the relationship between pediatric primary care involvement and use of hospice and home health care using generalized estimating equations. Results Of the 2,037 children who died between 2007 and 2010, 11% used hospice and 23% home health. Among all children, primary care was not related to hospice use and was associated with home health use [usual source of care (OR=1.83, p<0.05), comprehensive care (OR=1.60, p<0.05), continuous care (low: OR=1.49, p<0.05; moderate: OR=2.57, p<0.05; high: OR=2.12, p<0.05)]. Primary care for children 15 to 20 years was related to hospice use [usual source of care (OR=4.06, p<0.05), continuous care (low: OR=4.92, p<0.05; moderate OR=4.09, p<0.05; high OR=3.92, p<0.05)]. Primary care for children under 5 years was associated with home health use [usual source of care (OR=2.59, p<0.05), comprehensive care (OR=2.49, p<0.05), continuous care (low: OR=2.22, p<0.05; moderate: OR=3.64, p<0.05; high: OR=3.62, p<0.05)]. For children 6 to 14 years, this association was seen with continuous care [moderate: (OR=2.38, p<0.05); high (OR=2.13, p<0.05)]. Home health for children 15 to 20 years was related to continuous care [moderate: (OR=2.32, p<0.05)]. Conclusions Primary care involvement affected hospice use among older age groups and home health use among younger age groups. These findings underscore the need for clinical knowledge about end-of-life care for children of all ages among primary care providers.

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May 2017 List