title: Comparison of pediatric and adult hospice patients using electronic medical record data from nine hospices in the United States, 2008-2012.
abstract: BACKGROUND
  Most pediatric hospice patients receive services from agencies typically oriented to adults. Information regarding how pediatric hospice patients differ from adult hospice patients is lacking.
  
  
  OBJECTIVE
  We aim to assess differences between pediatric and adult hospice patients regarding patient characteristics and outcomes.
  
  
  METHODS
  We compiled a retrospective inception cohort of patients enrolled at nine hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness) between August 1, 2008 and June 30, 2012. Measurements included patient characteristics and outcomes, including discharge from hospice and site of death.
  
  
  RESULTS
  Among 126,620 hospice patients, 986 (0.8%) were 18 years of age or younger. Pediatric patients were less likely to have an admitting diagnosis of cancer (odds ratio [OR] 0.62; 95% confidence interval [CI]: 0.54-0.72). Although children were less likely to use oxygen at enrollment (OR 0.31; 95% CI: 0.26-0.37), they were more likely to have an enteral feeding tube (OR 4.04; 95% CI: 3.49-4.67). Pediatric patients were half as likely as adults to have a do-not-resuscitate order (DNR) order upon hospice enrollment (OR 0.52; 95% CI: 0.46-0.59). The average hospice length of stay for pediatric patients was longer than that of adults (103 days versus 66 days, p<0.001). Children were more likely to leave hospice care (OR 2.59; 95% CI: 2.00-3.34), but among patients who died while enrolled in hospice, pediatric patients were more likely to die at home (OR 3.25; 95% CI: 2.27-3.88).
  
  
  CONCLUSIONS
  Pediatric hospice patients differ from adult patients in their broader range of underlying diagnoses and their use of hospice services.
authors.affiliation: 1 Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Laura
authors.initials: L
authors.lastname: Dingfield
authors.forename: Laura
authors.initials: L
authors.lastname: Bender
authors.forename: Pamela
authors.initials: P
authors.lastname: Harris
authors.forename: Kristina
authors.initials: K
authors.lastname: Newport
authors.forename: Margo
authors.initials: M
authors.lastname: Hoover-Regan
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.forename: Sheila
authors.initials: S
authors.lastname: Clifford
authors.forename: David
authors.initials: D
authors.lastname: Casarett
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009859:Oncology Nursing / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult