title: Effect of pediatric palliative care programs on health care resource utilization and costs among children with life-threatening conditions: a systematic review of comparative studies.
abstract: BACKGROUND
  Pediatric palliative care is a relatively new and evolving field, and the cost of pediatric palliative care programs is unclear. We conducted a systematic review to compare inpatient health care utilization and costs among children with life-threatening conditions who have accessed a pediatric palliative care program and those who have not.
  
  
  METHODS
  We searched MEDLINE, Embase, CINAHL and LILACS databases from January 2000 to July 2013, as well as the grey literature, for experimental or observational studies that compared pediatric palliative care programs with usual care. Outcomes of interest included hospital admissions, length of stay and health care costs.
  
  
  RESULTS
  Of the 5193 records identified, we reviewed 109 in full and included 11 in our study. The overall quality of the studies was moderate to low. We observed mixed results for all outcomes. Compared with patients receiving usual care, fewer patients in the palliative care group had hospital admissions and fewer of those with cancer had planned hospital admissions. In contrast, no effects were observed regarding the overall number of hospital, emergency or outpatient admissions. Conflicting results were observed with regards to critical care utilization. Studies showed a trend toward shorter lengths of stay in hospital in the palliative care group. However, a single study that also considered inpatient time in hospice facilities found an increase in total length of stay, which showed a shift in the setting of health care utilization. We observed no conclusive trend in the effects on cost.
  
  
  CONCLUSIONS
  Evidence suggests that pediatric palliative care programs may result in a shift of utilization to other health care settings beyond hospital care. These settings should be considered when measuring resource utilization and costs.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC ; Centre for Clinical Epidemiology and Evaluation, Vancouver, BC.
authors.forename: Tania
authors.initials: T
authors.lastname: Conte
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC ; Centre for Clinical Epidemiology and Evaluation, Vancouver, BC.
authors.forename: Craig
authors.initials: C
authors.lastname: Mitton
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC ; Centre for Clinical Epidemiology and Evaluation, Vancouver, BC.
authors.forename: Logan M
authors.initials: LM
authors.lastname: Trenaman
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC ; Canuck Place Children's Hospice, Vancouver, BC.
authors.forename: Negar
authors.initials: N
authors.lastname: Chavoshi
authors.affiliation: Canuck Place Children's Hospice, Vancouver, BC ; Child and Family Research Institute, Vancouver, BC ; Division of General Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, BC.
authors.forename: Harold
authors.initials: H
authors.lastname: Siden
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