Pediatric palliative care: describing hospice users and identifying factors that affect hospice expenditures.

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 pediatric hospice care. This study seeks to describe Medicaid pediatric hospice and nonhospice users and to identify factors that affect hospice expenditures. DESIGN: Analyses of Medicaid administrative data and death certificate data. PARTICIPANTS: A total of 1527 children in Florida Medicaid program. RESULTS: Few children in the sample used hospice services (11%) and the dominant location of death was home for hospice users (55%). Descriptive analyses show that pediatric hospice users had higher inpatient, outpatient, emergency department, and pharmacy expenditures than nonhospice users. Regression results suggest that black non-Hispanic, Hispanic, and children of other races had $730 to $880 fewer hospice expenditures than Whites. Higher hospice expenditures ($970) were associated with longer enrollment spans. CONCLUSIONS: Descriptive analyses suggest that there are differences between pediatric hospice and nonhospice 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.