Effect of pediatric palliative care programs on health care resource utilization and costs among children with life-threatening conditions: a systematic review of comparative studies

Conte, Tania; Mitton, Craig; Trenaman, Logan; Chavoshi, Negar; Siden, Harold

doi:10.9778/cmajo.20140044

Cited by 41 publications

(30 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The authors reported no conclusive findings due to conflicting results on cost of care and an overall trend of reduction in length of stay (19). The cost decrease we find in this study, therefore, is consistent with some studies(20-23) but inconsistent with others, including a more M A N U S C R I P T…”

Section: Discussionsupporting

confidence: 58%

Cost Analysis and Policy Implications of a Pediatric Palliative Care Program

Gans

Hadler²,

Chen³

et al. 2016

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

Context. In 2010, California launched Partners for Children (PFC), a pediatric palliative care pilot program offering hospice-like services for children eligible for full-scope Medicaid delivered concurrently with curative care, regardless of the child's life expectancy. Objectives.We assessed the change from prior to PFC enrollment to the enrolled period in: (1) health care costs per enrollee per month (PEPM); (2) costs by service type and diagnosis category; and, (3) health care utilization (days of inpatient care and length of hospital stay). Methods.A pre-post analysis compared enrollees' health care costs and utilization up to 24 months prior to enrollment with their costs during participation in the pilot, from January 2010 through December 2012. Analyses were conducted using paid Medicaid claims and program enrollment data.Results. The average PEPM health care costs of program enrollees decreased by $3,331 from prior to their participation in PFC to the enrolled period, driven by a reduction in inpatient costs of $4,897 PEPM. PFC enrollees experienced a nearly 50% reduction in the average number of inpatient days per month, from 4.2 to 2.3. Average length of stay per hospitalization dropped from an average of 16.7 days prior to enrollment to 6.5 days while in the program. Conclusion.Through the provision of home-based therapeutic services, 24/7 access to medical advice, and enhanced, personally tailored care coordination, PFC demonstrated an effective way to reduce costs for children with life-limiting conditions by moving from costly inpatient care to more coordinated and less expensive outpatient care. PFC's home-based care strategy is a cost-effective model for pediatric palliative care elsewhere.

show abstract

Section: Discussionsupporting

confidence: 58%

Cost Analysis and Policy Implications of a Pediatric Palliative Care Program

Gans

Hadler²,

Chen³

et al. 2016

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

show abstract

“…Priorities for CPC research generally are varied, with research in HICs focusing on issues such as service evaluation,50–52 decision making,46 53 the impact of educational programmes,54 55 telehealth,56 57 preferred place of death,58 resource utilisation and costs,59 60 pain management,40 61 perinatal palliative care,62 screening for palliative care,63 64 and quality-of-life measures 65…”

Section: Status Of the Sciencementioning

confidence: 99%

Children's palliative care in low- and middle-income countries

Downing

Powell²,

Marston

et al. 2015

Arch Dis Child

View full text Add to dashboard Cite

One-third of the global population is aged under 20 years. For children with life-limiting conditions, palliative care services are required. However, despite 80% of global need occurring in low- and middle-income countries (LMICs), the majority of children's palliative care (CPC) is provided in high-income countries. This paper reviews the status of CPC services in LMICs--highlighting examples of best practice among service models in Malawi, Indonesia and Belarus--before reviewing the status of the extant research in this field. It concludes that while much has been achieved in palliative care for adults, less attention has been devoted to the education, clinical practice, funding and research needed to ensure children and young people receive the palliative care they need.

show abstract

“…28 However, a recent systematic review found conflicting results with 6 of 8 included studies indicating reduced overall costs when care was provided by a PPC team, but 2 studies finding an increase in costs. 29 Most included studies, plus a more recent analysis of costs associated with specialist PPC services, focused only on hospital-based costs rather than including costs that may have shifted to other settings, such as home care and hospice. 29,30 Because of universal health care coverage in Canada, we were able to track expenditures across multiple sectors, including home care; however, the costs associated with care in a freestanding hospice paid through philanthropic support were not included in our analysis.…”

Section: Tablementioning

confidence: 99%

“…29 Most included studies, plus a more recent analysis of costs associated with specialist PPC services, focused only on hospital-based costs rather than including costs that may have shifted to other settings, such as home care and hospice. 29,30 Because of universal health care coverage in Canada, we were able to track expenditures across multiple sectors, including home care; however, the costs associated with care in a freestanding hospice paid through philanthropic support were not included in our analysis. Unfortunately, we were also unable to determine which children received specialized PPC services due to nonspecific billing codes used by these teams.…”

Section: Tablementioning

confidence: 99%