HOSPITALIZATION OUTCOMES IN CHILDREN WITH END OF-LIFE CARE MEASURES

Abstract

Learning Objectives: Care at end of life in adults is known to account for a large proportion of health care resources. Current national estimates of outcomes in hospitalized children with end of life care are unknown. Using a large nationwide sample, we sought to characterize outcomes in hospitalized children who received end of life care measures. Methods: We performed a retrospective analysis of the Nationwide Inpatient Sample for years 2012 and 2013. All patients aged up to 17 years who had End of Life Care (ELC) treatment in the hospital were selected. Demographic characteristics of this cohort were examined. Outcomes examined included: hospitalization charges (HC), length of stay (LOS), and disposition status. Results: During the study period, a total of 9,785 children had ELC in hospitals. The mean age of this cohort was 4 years. Males comprised 53% of patients. Whites (49.8%) were the most frequently reported race followed by Hispanics(21.8%), Blacks(16.8%), Asians/Pacific Islanders (3.8%), Native Americans (1.3%), and other races (6.5%). 90% of this cohort was admitted on an emergency/urgent basis. The major diagnostic categories to which the patients belonged to included: Newborns/Neonates with conditions originating in perinatal period (37.8%), diseases of nervous system (14%), diseases of respiratory system (13.4%), myeloproliferative diseases/poorly differentiated neoplasms(5.7%), and disease of circulatory system(5.6%). Medicaid(53.3%) and private insurance plans(35.8%) were predominating payers. 24.3% were discharged routinely, 1.9% were transferred to another hospital, 4.4% were discharged to long term care facilities, 17.8% were discharged to home health care, and 51.4% died during hospitalization. The mean LOS in hospital was 14.4days and the total hospitalization days across the entire USA was 141,065 days. The mean HC was $183,202 and the total HC across the entire USA for this cohort of patients receiving ELC was $1.7 Billion. Conclusions: End of life care in hospitalized children accounts for considerable resource utilization. Strategies to optimize care, costs and quality at end of life are needed.