title: Pediatric Primary Care Involvement in End-of-Life Care for Children.
abstract: OBJECTIVE
  To examine the relationship between pediatric primary care involvement and hospice and home health care use at end of life.
  
  
  METHODS
  California Medicaid data were used to estimate the relationship between pediatric primary care involvement and use of hospice and home health care using generalized estimating equations.
  
  
  RESULTS
  Of the 2037 children who died between 2007 and 2010, 11% used hospice and 23% used home health. Among all children, primary care was not related to hospice use and was associated with home health use, usual source of care (OR = 1.83, P < .05), comprehensive care (OR = 1.60, P < .05), and continuous care (low: OR = 1.49, P < .05; moderate: OR = 2.57, P < .05; high: OR = 2.12, P < .05). Primary care for children aged 15 to 20 years was related to hospice use, usual source of care (OR = 4.06, P < .05) and continuous care (low: OR = 4.92, P < .05; moderate OR = 4.09, P < .05; high OR = 3.92, P < .05). Primary care for children under 5 years was associated with home health use, usual source of care (OR = 2.59, P < .05), comprehensive care (OR = 2.49, P < .05), and continuous care (low: OR = 2.22, P < .05; moderate: OR = 3.64, P < .05; high: OR = 3.62, P < .05). For children aged 6 to 14 years, this association was seen with continuous care (moderate: OR = 2.38, P < .05; high: OR = 2.13, P < .05). Home health for children aged 15 to 20 years was related to continuous care (moderate: OR = 2.32, P < .05).
  
  
  CONCLUSIONS
  Primary care involvement affected hospice use among older age-groups and home health use among younger age-groups. These findings underscore the need for clinical knowledge about end-of-life care for children of all ages among primary care providers.
authors.affiliation: 1 College of Nursing, University of Tennessee, Knoxville, TN, USA.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Lindley
authors.affiliation: 2 Maya Angelou Center for Health Equity Social Sciences & Health Policy, Wake Forest Baptist Medical Center, Wake Forest, NC, USA.
authors.forename: Savithri
authors.initials: S
authors.lastname: Nageswaran
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002140:California; D002648:Child; D002675:Child, Preschool; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D017051:Hospice Care / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Medicaid; end of life; home health care; hospice care; pediatric; primary care