Measuring the Impact of Pediatric Palliative Care on Hospital Utilization and Costs Among Children with Complex Chronic Conditions Approaching Death (FR481A)

Abstract

•Contrast levels of medical complexity among children who received a palliative care consultation to those children who did not.•Evaluate the association between palliative care consultation and hospital utilization. The impact of inpatient pediatric palliative care consultation is unknown, particularly among children with medical complexity. To characterize the effects of palliative care consultation on end-of-life hospital utilization, costs, and intensive care unit (ICU) death among medically complex children. We conducted a retrospective cohort study of children under age 19 with at least one complex chronic condition who died within a 4-year period. Each child had at least one hospitalization lasting 4 or more days or presented to the hospital more than once within the study period. Among children who received palliative care consultation versus those who did not, we compared days hospitalized in the 30 days prior to death, average daily hospital charges within that period, and whether death occurred inside an ICU. We used descriptive statistics and multivariable regression to evaluate associations between palliative care consultation and each of our study outcomes. We included 194 children, more than half of whom died in the hospital, and nearly half of whom received a palliative care consultation more than 30 days prior to death. There was greater medical complexity within the palliative care group (p=0.009), and pediatric palliative care consultation was associated with more hospital days in the last 30 days of life (p<0.0001). There was no difference in daily hospital charges (p=0.15) or ICU death (p=0.93) between groups, nor was palliative care consultation found to influence these outcomes in our regression models. Pediatric palliative care consultation was associated with greater patient complexity and more days hospitalized in the last 30 days of life without an associated rise in hospital charges or increased incidence of ICU death.