Maya N McKee1, Brett K Palama2, Matt Hall3, James L LaBelle4, Nicole L Bohr5,6, K Sarah Hoehn7. 1. Pritzker School of Medicine, University of Chicago, Chicago, IL. 2. Department of Pediatrics, University of Chicago Medicine Comer Children's Hospital, Chicago, IL. 3. Children's Hospital Association, Lenexa, KS. 4. Department of Pediatric Hematology, Oncology & Stem Cell Transplantation, University of Chicago, Comer Children's Hospital, Chicago, IL. 5. Department of Nursing Research and EBP, University of Chicago Medical Center, Chicago, IL. 6. Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, University of Chicago Medicine, Chicago, IL. 7. Department of Pediatric Critical Care, University of Chicago Medicine Comer Children's Hospital, Chicago, IL.
Abstract
OBJECTIVES: Racial/ethnic disparities in utilizing inpatient palliative care services are well documented in the adult literature. However, the impact of racial/ethnic disparities in the context of pediatric palliative care is less well understood even in high-acuity patient populations such as stem cell transplant patients. We investigated racial/ethnic differences in the utilization of inpatient palliative care consultations (IPCCs) for pediatric stem cell transplant patients. STUDY DESIGN: A retrospective cohort study was conducted using the Pediatric Health Information System database. A generalized linear mixed effects model was developed to assess demographic and clinical characteristics associated with the likelihood of receiving IPCC. SETTING: Thirty-eight tertiary pediatric hospitals in the United States. PATIENTS: Pediatric patients undergoing stem cell transplantation for any indication from January 2017 to December 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 1,193 inpatient encounters studied, 12% (n = 143) included a palliative care consult. IPCC rates varied across hospitals with a median rate of 5.97% (interquartile range, 0.00-20.71). In multivariable analyses, Hispanic/Latinx patients were 59% less likely to receive IPCC compared with non-Hispanic White patients (odds ratio [OR], 0.41; 95% CI, 0.21-0.78). This difference persisted after adjusting for all other sociodemographic and clinical factors. In terms of the other clinical characteristics, having a malignant condition and mechanical ventilation were associated with significantly increased odds of receiving IPCC for the entire cohort (OR Malignancy: 1.93; 95% CI: 1.07-3.51; OR Mechanical Ventilation: 2.37; 95% CI: 1.36-4.13). The remainder of the variables were not found to be significantly associated with IPCC. CONCLUSIONS: Racial and ethnic differences exist in the likelihood of receiving palliative care consultations among hospitalized pediatric stem cell transplant recipients. Evaluating the impact of systemic racism and social determinants on palliative care medicine as well as standardizing early integration of IPCC may potentially mitigate disparities in this population.
OBJECTIVES: Racial/ethnic disparities in utilizing inpatient palliative care services are well documented in the adult literature. However, the impact of racial/ethnic disparities in the context of pediatric palliative care is less well understood even in high-acuity patient populations such as stem cell transplant patients. We investigated racial/ethnic differences in the utilization of inpatient palliative care consultations (IPCCs) for pediatric stem cell transplant patients. STUDY DESIGN: A retrospective cohort study was conducted using the Pediatric Health Information System database. A generalized linear mixed effects model was developed to assess demographic and clinical characteristics associated with the likelihood of receiving IPCC. SETTING: Thirty-eight tertiary pediatric hospitals in the United States. PATIENTS: Pediatric patients undergoing stem cell transplantation for any indication from January 2017 to December 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 1,193 inpatient encounters studied, 12% (n = 143) included a palliative care consult. IPCC rates varied across hospitals with a median rate of 5.97% (interquartile range, 0.00-20.71). In multivariable analyses, Hispanic/Latinx patients were 59% less likely to receive IPCC compared with non-Hispanic White patients (odds ratio [OR], 0.41; 95% CI, 0.21-0.78). This difference persisted after adjusting for all other sociodemographic and clinical factors. In terms of the other clinical characteristics, having a malignant condition and mechanical ventilation were associated with significantly increased odds of receiving IPCC for the entire cohort (OR Malignancy: 1.93; 95% CI: 1.07-3.51; OR Mechanical Ventilation: 2.37; 95% CI: 1.36-4.13). The remainder of the variables were not found to be significantly associated with IPCC. CONCLUSIONS: Racial and ethnic differences exist in the likelihood of receiving palliative care consultations among hospitalized pediatric stem cell transplant recipients. Evaluating the impact of systemic racism and social determinants on palliative care medicine as well as standardizing early integration of IPCC may potentially mitigate disparities in this population.
Authors: Meaghann S Weaver; Katherine E Heinze; Katherine P Kelly; Lori Wiener; Robert L Casey; Cynthia J Bell; Joanne Wolfe; Amy M Garee; Anne Watson; Pamela S Hinds Journal: Pediatr Blood Cancer Date: 2015-12 Impact factor: 3.167
Authors: K Scott Baker; Fausto R Loberiza; Hongmei Yu; Mitchell S Cairo; Brian J Bolwell; Willem A Bujan-Boza; Bruce M Camitta; Juan Jose Garcia; Winston G Ho; Jane L Liesveld; Dipnarine Maharaj; David I Marks; Kirk R Schultz; Peter Wiernik; Axel R Zander; Mary M Horowitz; Armand Keating; Daniel J Weisdorf Journal: J Clin Oncol Date: 2005-09-06 Impact factor: 44.544