P0550 - Is inpatient hospice unit utilization affected by the availability of a pediatric specific unit?

Background: Family preferences for location of end-of-life care are important considerations when treating children with life-limiting conditions. Home and hospital have been the most common locations for end of life care in pediatrics. There is limited research on whether families would choose to receive end-of-life care in an inpatient hospice facility if a pediatric-specific facility was available.

Objectives: We examined changes in family utilization of inpatient hospice services with the availability of an inpatient pediatric hospice facility (PHF). Prior to opening of the PHF, an adult inpatient hospice facility was utilized for inpatient pediatric hospice care.

Methods: We conducted a retrospective cohort study with data collected on location of death five years prior to and five years following the opening of a PHF that receives referrals from a large children’s hospital. Two data sources from the hospice organization were used: 1) a dataset on origins and outcomes of referrals to pediatric hospice care and 2) a dataset on location of death for all pediatric patients who had any contact with the hospice system. Chi-square analyses were conducted to assess the impact of the PHF opening on referral outcomes and location of death.

Results: Significant results were found with respect to both referral outcomes and location of death. There was a significant increase in percent of families who engaged in inpatient hospice services (14 vs. 33%). The percent of patients who died in an inpatient hospice unit also increased significantly with the opening of the pediatric facility (23 vs. 55%). Consistent with our hypotheses, we found that availability of a PHF was associated with increased utilization from a number of perspectives. First, providers increased their referrals to hospice with the opening of the PHF– this was true for both providers from the children’s hospital and providers in the community. Families, in turn, were more likely to engage in inpatient services after the opening of the PHF, and perhaps most importantly, less likely to not receive any services from hospice. Similarly, the opening of the PHF was associated with an increase in families who experienced the death of a child with inpatient hospice care relative to home-based care. While the goal of the PHF was not to displace home-based hospice services, the fact that this did occur may point to the value of inpatient hospice care for families and referring providers as a third option for location of end of life care.

Conclusion: Although we recognize there are limitations to this cohort study, results indicate that provider and family utilization of an inpatient hospice facility increases with the availability of a pediatric-specific facility.