Pediatric Primary Care Involvement in End-of-Life Care for Children

Am J Hosp Palliat Care. 2017 Mar;34(2):135-141. doi: 10.1177/1049909115609589. Epub 2016 Jul 11.

Abstract

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 2037 children who died between 2007 and 2010, 11% used hospice and 23% used 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 < .05), comprehensive care (OR = 1.60, P < .05), and continuous care (low: OR = 1.49, P < .05; moderate: OR = 2.57, P < .05; high: OR = 2.12, P < .05). Primary care for children aged 15 to 20 years was related to hospice use, usual source of care (OR = 4.06, P < .05) and continuous care (low: OR = 4.92, P < .05; moderate OR = 4.09, P < .05; high OR = 3.92, P < .05). Primary care for children under 5 years was associated with home health use, usual source of care (OR = 2.59, P < .05), comprehensive care (OR = 2.49, P < .05), and continuous care (low: OR = 2.22, P < .05; moderate: OR = 3.64, P < .05; high: OR = 3.62, P < .05). For children aged 6 to 14 years, this association was seen with continuous care (moderate: OR = 2.38, P < .05; high: OR = 2.13, P < .05). Home health for children aged 15 to 20 years was related to continuous care (moderate: OR = 2.32, P < .05).

Conclusion: 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.

Keywords: Medicaid; end of life; home health care; hospice care; pediatric; primary care.

MeSH terms

  • Adolescent
  • Age Factors
  • California
  • Child
  • Child, Preschool
  • Female
  • Home Care Services / statistics & numerical data
  • Hospice Care / statistics & numerical data
  • Humans
  • Infant
  • Male
  • Primary Health Care / statistics & numerical data*
  • Retrospective Studies
  • Terminal Care / statistics & numerical data*
  • Young Adult