Effectiveness of Pediatric Concurrent Hospice Care to Improve Continuity of Care.

Abstract

The 2010 Patient Protection and Affordable Care Act (ACA) mandated landmark hospice care legislation for children at end of life. Little is known about the impact of pediatric concurrent hospice care. The purpose of this study was to examine the effect of pediatric concurrent vs standard hospice care on end-of-life care continuity among Medicaid beneficiaries. Using national Medicaid data, we conducted a quasi-experimental designed study to estimate the effect of concurrent vs standard hospice care to improve end-of-life care continuity for children. Care continuity (i.e., hospice length of stay, hospice disenrollment, emergency room transition, and inpatient transition) was measured via claims data. Exposures were concurrent hospice vs standard hospice care. Using instrumental variable analysis, the effectiveness of exposures on care continuity was compared. Concurrent hospice care affected care continuity. It resulted in longer lengths of stays in hospice (β = 2.76, P < .001) and reduced hospice live discharges (β = -2.80, P < .05), compared to standard hospice care. Concurrent care was not effective at reducing emergency room (β = 2.09, P < .001) or inpatient care (β = .007, P < .05) transitions during hospice enrollment. Our study provides critical insight into the quality of care delivered for children at end of life. These findings have policy implications.