title: Factors associated with the provision of hospice care for children.
abstract: BACKGROUND
  Children at the end of life often lack access to hospice care at home or in a dedicated facility. The factors that may influence whether or not hospices provide pediatric care are relatively unknown.
  
  
  OBJECTIVE
  The purpose of this study was to understand the institutional and resource factors associated with provision of pediatric hospice care.
  
  
  METHODS
  This study used a retrospective, longitudinal design. The main data source was the 2002 to 2008 California State Hospice Utilization Data Files. The sample size was 311 hospices or 1368 hospice observations over seven years. Drawing on institutional and resource dependence theory, this study used generalized estimating equations to examine the institutional and resource factors associated with provision of pediatric hospice care. Interaction terms were included to assess the moderating effect of resource factors on the relationship between institutional factors and provision of care.
  
  
  RESULTS
  Membership in professional groups increased the probability (19%) of offering hospice services for children. Small- (-22%) and medium-sized (-11%) hospices were less likely to provide care for children. The probability of providing pediatric hospice care diminished (-23%) when competition increased in the prior year. Additionally, small size attenuated the accreditation-provision relationship and medium size magnified the membership-provision relationship.
  
  
  CONCLUSIONS
  Professional membership may promote conformity to industry standards of pediatric care and remove the unknowns of providing hospice care for children. Hospices, especially medium-sized hospices, interested in developing or expanding care for children may benefit by identifying a pediatric champion to join a professional group.
authors.affiliation: College of Nursing, University of Tennessee, Knoxville, TN 37996, USA. llindley@utk.edu
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Lindley
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Mark
authors.forename: Shoou-Yih
authors.initials: SY
authors.lastname: Daniel Lee
authors.forename: Marisa
authors.initials: M
authors.lastname: Domino
authors.forename: Mi-Kyung
authors.initials: MK
authors.lastname: Song
authors.forename: Julie
authors.initials: J
authors.lastname: Jacobson Vann
mesh_terms: D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data*; D006738:Hospices / Q000600:supply & distribution*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male