title: Pediatric palliative care and inpatient hospital costs: a longitudinal cohort study.
abstract: BACKGROUND
  Pediatric palliative care (PPC) improves the quality of life for children with life-limiting conditions, but the cost of care associated with PPC has not been quantified. This study examined the association between inpatient cost and receipt of PPC among high-cost inpatients.
  
  
  METHODS
  The 10% most costly inpatients treated at a children's hospital in 2010 were studied, and factors associated with receipt of PPC were determined. Among patients dying during 2010, we compared 2010 inpatient costs between PPC recipients and nonrecipients. Inpatient costs during the 2-year follow up period between PPC recipients and nonrecipients were also compared. Patients were analyzed in 2 groups: those who died and those who survived the 2-year follow-up.
  
  
  RESULTS
  Of 902 patients, 86 (10%) received PPC. Technology dependence, older age, multiple chronic conditions, PICU admission, and death in 2010 were independently associated with receipt of PPC. PPC recipients had increased inpatient costs compared with nonrecipients during 2010. Among patients who died during the 2-year follow-up, PPC recipients had significantly lower inpatient costs. Among survivors, PPC recipients had greater inpatient costs. When controlling for patient complexity, differences in inpatient costs were not significant.
  
  
  CONCLUSIONS
  The relationship of PPC to inpatient costs is complex. PPC seems to lower costs among patients approaching death. Patients selectively referred to PPC who survive most often do so with chronic serious illnesses that predispose them to remain lifelong high-resource utilizers.
authors: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; andrew.gerald.smith@hsc.utah.edu.
authors: Andrew G
authors: AG
authors: Smith
authors: Primary Children's Hospital, Salt Lake City, Utah;
authors: Seth
authors: S
authors: Andrews
authors: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;
authors: Susan L
authors: SL
authors: Bratton
authors: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;
authors: Joan
authors: J
authors: Sheetz
authors: Pediatric Advanced Care Team and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Medical Ethics and Health Policy and the Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Chris
authors: C
authors: Feudtner
authors: Pediatric Advanced Care Team and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors: Wenjun
authors: W
authors: Zhong
authors: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;
authors: Christopher G
authors: CG
authors: Maloney
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008137:Longitudinal Studies; D008297:Male; D009313:National Health Programs / Q000191:economics*; D020380:Needs Assessment / Q000191:economics; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000191:economics*; D010348:Patient Care Team / Q000191:economics; D010372:Pediatrics / Q000191:economics*; D013727:Terminal Care / Q000191:economics
keywords: hospital cost; palliative care; pediatrics