The Effect of Pediatric Palliative Care Policy on Hospice Utilization Among California Medicaid Beneficiaries

Abstract

Background California implemented pediatric palliative care legislations that allowed children to receive curative and supportive care from diagnosis of a life-threatening, serious illness in 2010. Palliative care policies may improve access to hospice care as children near end of life. Objectives To examine the effect of the palliative care policy on hospice utilization for children and their families was investigated. Research Design Using 2007 and 2010 California Medicaid data, a difference-in-difference analysis was conducted to analyze hospice use (i.e., hospice enrollment, hospice length of stay) changes for children who resided in pediatric policy counties relative to those who did not. Population Studied The sample of children in California who died with a life-threatening, serious illness in 2007 and 2010 equaled 979 children. Results Over 10% of children enrolled in hospice care with an average of less than 3 days of hospice care. The palliative care policy did not have any effect on hospice enrollment. However, the policy was positively associated with increasing days in hospice care (IRR= 5.61, p<0.05). The rate of hospice length of stay increased by a factor of 5.61 for children in palliative care counties, compared to children unaffected by the policy. Conclusions The pediatric palliative care policy was associated with longer lengths of stay in hospice once the children were enrolled. Policies promoting palliative care are critical to ensuring access to hospice care for children.

Children Enrolled in Hospice Care Under Commercial Insurance: A Comparison of Different Age Groups

“…Children in this study averaged less than 5 days in hospice. This result was consistent with prior studies that examined hospice utilization among Medicaid beneficiaries, 9,16 including adolescents, 31 and those with intellectual disability. 32 Additionally, the finding that a majority of study participants visited their primary care physician in the last year of life was similar to the results of Lindley and Nageswaren 17 who found among Medicaid beneficiaries that over 60% of children had at least 1 visit to their primary care provider.…”

“…Separate groups of study variables were created a priori based on the Andersen Model for demographics, health characteristics, health care utilization, and health care spending. 7,9,16 Demographics included age, sex, insurance type, region, and metropolitan area. Age was categorized as <1 year, 1 to 5 years, 6 to 14 years, and 15 to 17 years.…”

“…Evidence suggests that a child's age, sex, and place of residence influence utilization of end-of-life care including hospice utilization, primary care visits, hospital admission, and emergency department (ED) visits. 9,[16][17][18] Enablers such as type of insurance have also been related to end-of-life care for children, 9,12,13,16 while the health of the child has been shown to be a critical driver of utilization and costs of care. 7,9,16 Thus, this framework suggests that predisposing, enabling, and need factors are potential considerations when examining health utilization and spending among commercially insured children at end of life.…”

End‐of‐life care quality for children with cancer who receive palliative care

“…38 Yet, limited access to pediatric-specific hospice services in certain geographic regions, hospice restrictions on the receipt of interventions at home such as blood transfusions, and variable state adoption and implementation of the provision, may influence enrollment. 8,[39][40][41][42] Additionally, an anticipated life expectancy of fewer than 6 months remains a criterion for hospice enrollment. 38 With the increased availability of precision medicine therapies for children with advanced cancer, prognostication may prove challenging, 43 potentially contributing to delayed or infrequent hospice referral or discontinuous enrollment.…”

Inequity in palliative care service full utilisation among patients with advanced cancer: a retrospective Cohort study

“…In palliative care, this model was successfully used to describe inequity related to adult patients' age [8], to paediatric patients [9][10][11], to family caregivers of palliative care patients [12,13] and to cancer survivors [14]. None of these studies specifically focussed on the health determinants in advanced cancer patients.…”