Andrew G Smith1, Seth Andrews2, Susan L Bratton3, Joan Sheetz3, Chris Feudtner4, Wenjun Zhong5, Christopher G Maloney3. 1. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; andrew.gerald.smith@hsc.utah.edu. 2. Primary Children's Hospital, Salt Lake City, Utah; 3. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; 4. 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. 5. Pediatric Advanced Care Team and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
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.
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: J Randall Curtis; Patsy D Treece; Elizabeth L Nielsen; Julia Gold; Paul S Ciechanowski; Sarah E Shannon; Nita Khandelwal; Jessica P Young; Ruth A Engelberg Journal: Am J Respir Crit Care Med Date: 2016-01-15 Impact factor: 21.405
Authors: Katherine E Nelson; James A Feinstein; Cynthia A Gerhardt; Abby R Rosenberg; Kimberley Widger; Jennifer A Faerber; Chris Feudtner Journal: Children (Basel) Date: 2018-02-26
Authors: Esther van Puffelen; Suzanne Polinder; Ilse Vanhorebeek; Pieter Jozef Wouters; Niek Bossche; Guido Peers; Sören Verstraete; Koen Felix Maria Joosten; Greet Van den Berghe; Sascha Cornelis Antonius Theodorus Verbruggen; Dieter Mesotten Journal: Crit Care Date: 2018-01-15 Impact factor: 9.097