A National Study of Healthcare Service Patterns at the End of Life Among Children With Cardiac Disease

Abstract

Background: Heart diseases are one of the leading causes of health-related deaths among children. Concurrent hospice care offers hospice and nonhospice healthcare services simultaneously, but the use of these services by children with cardiac disease has been rarely investigated. Objective: The aims of this study were to identify patterns of nonhospice healthcare services used in concurrent hospice care and describe the profile of children with cardiac disease in these clusters. Methods: This study was a retrospective cohort analysis of Medicaid claims data collected between 2011 and 2013 from 1635 pediatric cardiac patients. The analysis included descriptive statistics and latent class analysis. Results: Children in the sample used more than 314 000 nonhospice healthcare services. The most common services were inpatient hospital procedures, durable medical equipment, and home health. Latent class analysis clustered children into "moderate intensity" (60.0%) and "high intensity" classes (40.0%). Children in "moderate intensity" had dysrhythmias (31.7%), comorbidities (85.0%), mental/behavioral health conditions (55%), and technology dependence (71%). They commonly resided in urban areas (60.1%) in the Northeast (44.4%). The health profile of children in the "high intensity" class included dysrhythmias (39.4%), comorbidities (97.6%), mental/behavioral health conditions (71.5%), and technology dependence (85.8%). These children resided in rural communities (50.7%) in the South (53.1%). Conclusions: Two patterns of use of nonhospice healthcare services were identified in this study. This information may be used by nurses and other healthcare professionals working in concurrent hospice care to assess the healthcare service needs of children with cardiac conditions at the end of life.

Conceptualizing the Value of Pediatric Concurrent Hospice Care

“…Considering that children in concurrent hospice care have a mean length of stay of 89 days, this number suggests patients received a medical service every day they received concurrent hospice care 27 . More than 20 different categories of medical care services were identified, which varied by diagnosis (ie, neurological, cancer, cardiovascular) 28-30 . The most common type of service was inpatient hospital treatments (eg, enteral infusions, parenteral infusions, mechanical ventilation, transfusions), followed by durable medical equipment (eg, enteral feeding supplies, oxygen equipment, suctions/pumps).…”

“…27 More than 20 different categories of medical care services were identified, which varied by diagnosis (ie, neurological, cancer, cardiovascular). [28][29][30] The most common type of service was inpatient hospital treatments (eg, enteral infusions, parenteral infusions, mechanical ventilation, transfusions), followed by durable medical equipment (eg, enteral feeding supplies, oxygen equipment, suctions/pumps). Much of the care delivery focused on feeding and breathing.…”