The Effect of Pediatric Palliative Care Policy on Hospice Utilization Among California Medicaid Beneficiaries.
California implemented pediatric palliative care legislations that allowed children to receive curative and supportive care from diagnosis of a life-threatening serious illness in 2010. Palliative care policies may improve access to hospice care as children near end of life.



The aim of this study was to examine the effect of the palliative care policy on hospice utilization for children and their families was investigated.



Using 2007 and 2010 California Medicaid data, a difference-in-difference analysis was conducted to analyze hospice use (i.e., hospice enrollment, hospice length of stay) changes for children who resided in pediatric policy counties relative to those who did not. The sample of children in California who died with a life-threatening serious illness in 2007 and 2010 equaled 979 children.



More than 10% of children enrolled in hospice care with an average of less than 3 days of hospice care. The palliative care policy did not have any effect on hospice enrollment. However, the policy was positively associated with increasing days in hospice care (incidence rate ratio = 5.61, P < 0.05). The rate of hospice length of stay increased by a factor of 5.61 for children in palliative care counties compared with children unaffected by the policy.



The pediatric palliative care policy was associated with longer lengths of stay in hospice once the children were enrolled. Policies promoting palliative care are critical to ensuring access to hospice care for children.
College of Nursing, University of Tennessee, Knoxville, Tennessee, USA. Electronic address: llindley@utk.edu.
Lisa C
LC
Lindley
D000293:Adolescent; D002140:California; D002648:Child; D002675:Child, Preschool; D005260:Female; D006291:Health Policy; D017051:Hospice Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006738:Hospices / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008484:Medicaid; D010166:Palliative Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
Andersen behavioral model; Medicaid; Pediatric hospice utilization; pediatric palliative care policy
Am J Hosp Palliat Care. 2014 Aug;31(5):527-33
23838455
J Palliat Med. 2011 Nov;14(11):1217-23
21823906
Med Care. 2007 Dec;45(12):1216-20
18007173
Policy Brief UCLA Cent Health Policy Res. 2012 Aug;(PB2012-3):1-8
22946141
J Pediatr Health Care. 2013 Nov-Dec;27(6):511-6
24055071
J Palliat Med. 2008 Nov;11(9):1212-20
19021484
Adv Neonatal Care. 2010 Dec;10(6):287-93
21102170
Pediatrics. 2013 Nov;132(5):966-972
28448256
Omega (Westport). 2007-2008;56(1):89-99
18051022
J Palliat Med. 2014 Dec;17(12):1328-35
25375799
J Pain Symptom Manage. 2007 Aug;34(2):120-5
17583469
J Hosp Palliat Nurs. 2011 Mar;13(2):81-88
22822304
J Oncol Pract. 2014 May;10(3):174-7
24839276
JAMA. 2000 Nov 15;284(19):2469-75
11074776
Pediatrics. 2001 Jun;107(6):E99
11389297
Arch Pediatr Adolesc Med. 2009 Nov;163(11):986-92
19884588
Oncol Nurs Forum. 2009 Jul;36(4):446-53
19581235
Pediatr Nurs. 2007 Jul-Aug;33(4):335-41
17907734
Pediatrics. 2015 Jun;135(6):1115-25
25941306
Pediatr Blood Cancer. 2010 May;54(5):746-50
20063424
J Hosp Palliat Nurs. 2015 Apr;17(2):113-118
25983662
Pediatrics. 2008 Feb;121(2):282-8
18245419
J Pain Symptom Manage. 2013 Apr;45(4):701-11
22921174
J Clin Oncol. 2009 Feb 20;27(6):953-9
19114698
Arch Pediatr Adolesc Med. 2010 Sep;164(9):831-9
20819965
J Spec Pediatr Nurs. 2014 Oct;19(4):308-15
25131751
Am J Hosp Palliat Care. 2015 Mar;32(2):216-20
24445151
J Palliat Med. 2013 Nov;16(11):1388-93
24102460
J Pediatr Oncol Nurs. 2003 May-Jun;20(3):103-19
12776259
J Palliat Med. 2015 Mar;18(3):270-3
25210851
J Pain Symptom Manage. 2014 Oct;48(4):532-9
24680626
Blood. 2010 May 13;115(19):3879-85
20228275
MCN Am J Matern Child Nurs. 2007 Sep-Oct;32(5):311-9
17728594
Am J Hosp Palliat Care. 2017 Mar;34(2):135-141
26430133