title: Community-based pediatric palliative care for health related quality of life, hospital utilization and costs lessons learned from a pilot study.
abstract: BACKGROUND
  Children with chronic complex-medical conditions comprise a small minority of children who require substantial healthcare with major implications for hospital utilization and costs in pediatrics. Community-Based Pediatric Palliative Care (CBPPC) provides a holistic approach to patient care that can improve their quality of life and lead to reduced costs of hospital care. This study's purpose was to analyze and report unpublished evaluation study results from 2007 that demonstrate the potential for CBPPC on Health Related Quality of Life (HRQoL) and hospital utilization and costs in light of the increasing national focus on the care of children with complex-medical conditions, including the Affordable Care Act's emphasis on patient-centered outcomes.
  
  
  METHODS
  A multi-method research design used primary data collected from caregivers to determine the Program's potential impact on HRQoL, and administrative data to assess the Program's potential impact on hospital utilization and costs. Caregivers (n=53) of children enrolled in the Northeast Florida CBPPC program (Community PedsCare) through the years 2002-2007 were recruited for the Health Related Quality of Life (HRQoL) study. Children (n=48) enrolled in the Program through years 2000-2006 were included in the utilization and cost study.
  
  
  RESULTS
  HRQoL was generally high, and hospital charges per child declined by $1203 for total hospital services (p=.34) and $1047 for diagnostic charges per quarter (p=0.13). Hospital length of stay decreased from 2.92 days per quarter to 1.22 days per quarter (p<.05).
  
  
  CONCLUSIONS
  The decrease in hospital utilization and costs and the high HRQoL results indicate that CBPPC has the potential to influence important outcomes for the quality of care available for children with complex-medical conditions and their caregivers.
authors.affiliation: Division of Community and Societal Pediatrics, Department of Pediatrics, UF College of Medicine - Jacksonville, 841 Prudential Drive, Suite 1330 m, Jacksonville, FL, 32207, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Goldhagen
authors.affiliation: Baptist Health Research Institute, Baptist Health System, 836 Prudential Drive, Pavilion 6th Floor, Jacksonville, FL, 32207, USA. Mark.Fafard@bmcjax.com.
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0001-6963-6873
authors.initials: M
authors.lastname: Fafard
authors.affiliation: Division of Community and Societal Pediatrics, Department of Pediatrics, UF College of Medicine - Jacksonville, 841 Prudential Drive, Suite 1330 m, Jacksonville, FL, 32207, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Komatz
authors.affiliation: Community PedsCare, Community Hospice of Northeast Florida, 4266 Sunbeam Rd., Jacksonville, FL, 32257, USA.
authors.forename: Terry
authors.initials: T
authors.lastname: Eason
authors.affiliation: Center for Health Equity and Quality Research, UF College of Medicine-Jacksonville, 580 W. 8th St., Tower II, Room 6015, Jacksonville, FL, 32209, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Livingood
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics / Q000523:psychology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D005431:Florida; D017721:Hospital Costs; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care / Q000191:economics / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011788:Quality of Life; D055815:Young Adult
keywords: Chronic disease; Cost-effectiveness; Health related quality of life; Hospital utilization; Pediatric palliative care; Pilot study