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Pérez-Ardanaz B, Gutiérrez-Rodríguez L, Pelaez-Cantero MJ, Morales-Asencio JM, Gómez-González A, García-Piñero JM, Lupiañez-Perez I. Healthcare service use for children with chronic complex diseases: A longitudinal six-year follow-up study. J Pediatr Nurs 2024; 77:e132-e138. [PMID: 38594165 DOI: 10.1016/j.pedn.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE The objective was analysed the patterns use of healthcare services of this population and the influence of their clinical and sociodemographic characteristics. DESIGN AND METHODS A six-year longitudinal follow-up study was performed to evaluate the annual healthcare resources use and clinical data among children with complex chronic diseases in Spain between 2015 and 2021. The sample trends in healthcare usage and the associated factors were analysed using ANCOVA and multivariable linear regression models. RESULTS Patients had high attendance during the follow-up period, with >15 episodes year. This trend decreased over time, especially in children with oncological diseases compared with other diseases (F (16.75; 825.4) = 32.457; p < 0.001). A multivariable model showed that children with a greater number of comorbidities (β = 0.17), shorter survival time (β = -0.23), who had contact with the palliative care unit (β = 0.16), and whose mothers had a higher professional occupation (β = 0.14), had a greater use of the healthcare system. CONCLUSIONS Children with a higher number of comorbidities and the use of medical devices made a greater frequentation of health services, showing a trend of decreasing use over time. Socioeconomic factors such as mothers' occupational status determine healthcare frequentation. These results suggest the existence of persistent gaps in care coordination sustained over time. PRACTICAL IMPLICATIONS Systematized and coordinated models of care for this population should consider the presence of inequalities in health care use.
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Affiliation(s)
- Bibiana Pérez-Ardanaz
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - Laura Gutiérrez-Rodríguez
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | | | - José Miguel Morales-Asencio
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - Alberto Gómez-González
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
| | - José Miguel García-Piñero
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Pediatric Intensive Care Unit, Hospital Materno-Infantil, Málaga, Spain
| | - Inmaculada Lupiañez-Perez
- Universidad de Málaga, Faculty of Health Sciences, Department of Nursing, Spain; Instituto de Investigación Biomédica de Málaga-Bionand (IBIMA), Spain.
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Smith SM, Grossoehme DH, Cicozi K, Hiltunen A, Roth C, Richner G, Kim SS, Tram NK, Friebert S. Home-Based Pediatric Hospice and Palliative Care Provider Visits: Effects on Healthcare Utilization. J Pediatr 2024; 268:113929. [PMID: 38309523 DOI: 10.1016/j.jpeds.2024.113929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/05/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE This hypothesis-generating study sought to assess the impact of home-based hospice and palliative care (HBHPC) provider home visits (HV) on healthcare use. STUDY DESIGN Retrospective review of individuals ages 1 month to 21 years receiving an in-person HBHPC provider (MD/DO or APN) HV through 2 HBHPC programs in the Midwest from January 1, 2013, through December 31, 2018. Descriptive statistics were calculated for healthcare use variables. Paired t test or Wilcoxon signed-rank test compared the changes in healthcare use the year before and year after initial provider HVs. RESULTS The cohort included 195 individuals (49% female), with diagnoses composed of 49% neurologic, 30% congenital chromosomal, 11% oncologic, 7% cardiac, and 3% other. After implementation of HBHPC services, these patients showed decreases in the median (IQR) number of intensive care unit days (before HV, 12 [IQR, 4-37]; after HV, 0 [IQR, 0-8]; P < .001); inpatient admissions (before HV, 1 [IQR, 1-3]; after HV, 1 [IQR, 0-2]; P = .005); and number of inpatient days (before HV, 5 [IQR, 1-19]; after HV, 2 [IQR, 0-8]; P = .009). There was an increase in clinically relevant phone calls to the HBHPC team (before HV, 1 [IQR, 0-4] vs after HV, 4 [IQR, 1-7]; P < .001) and calls to the HBHPC team before emergency department visits (before HV, 0 [IQR, 0-0] vs after HV, 1 [IQR, 1-2]; P < .001). CONCLUSION HBHPC provider HVs were associated with fewer inpatient admissions, hospital days, and intensive care unit days, and increased clinically relevant phone calls and phone calls before emergency department visit. These findings indicate that HBHPC HV may contribute to decreased inpatient use and increased use of the HBHPC team.
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Affiliation(s)
- Steven M Smith
- Department of Anesthesia Section of Palliative Care and Hospice, Nationwide Children's Hospital, Columbus, OH.
| | - Daniel H Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH; Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH
| | - Kate Cicozi
- Department of Anesthesia Section of Palliative Care and Hospice, Nationwide Children's Hospital, Columbus, OH
| | - Audrey Hiltunen
- Department of Anesthesia Section of Palliative Care and Hospice, Nationwide Children's Hospital, Columbus, OH
| | - Catherine Roth
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Gwendolyn Richner
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH; Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH
| | - Stephani S Kim
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Nguyen K Tram
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH; Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH
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Widger K, Brennenstuhl S, Tanuseputro P, Nelson KE, Rapoport A, Seow H, Siden H, Vadeboncoeur C, Gupta S. Location of death among children with life-threatening conditions: a national population-based observational study using the Canadian Vital Statistics Database (2008-2014). CMAJ Open 2023; 11:E298-E304. [PMID: 37015742 PMCID: PMC10079309 DOI: 10.9778/cmajo.20220070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Patterns in location of death among children with life-threatening conditions (e.g., cancer, genetic disorders, neurologic conditions) may reveal important inequities in access to hospital and community support services. We aimed to identify demographic, socioeconomic and geographic factors associated with variations in location of death for children across Canada with life-threatening conditions. METHODS We used a retrospective observational cohort design and the Canadian Vital Statistics Database to identify children aged 19 years or younger who died from a life-threatening condition between Jan. 1, 2008, and Dec. 31, 2014. We used multivariable logistic regression to determine predictors of in-hospital death for children aged 1 month to 19 years, and for neonates younger than 1 month. RESULTS Overall, 13 115 decedents younger than 19 years had life-threatening conditions. Of 5250 children and 7865 neonates, 74.2% and 98.1%, respectively, died in hospital. Among children, we found a higher proportion of hospital deaths in the lowest (v. highest) income quintile (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.28-1.97), and a lower proportion among children living more than 400 km (v. < 50 km) from a pediatric hospital (OR 0.73, 95% CI 0.65-0.86). Compared with Ontario, hospital death was most common in Quebec (OR 1.38, 95% CI 1.14-1.67) and least common in British Columbia (OR 0.43, 95% CI 0.34-0.53). Compared with an oncologic cause of death, all causes except neurologic and metabolic conditions had significantly higher odds of dying in hospital. INTERPRETATION In addition to demographics, we identified socioeconomic and geographic differences in location of death, suggesting potential inequities in access to high-quality care at the end of life. Health care policies and practices must ensure equitable access to services for children across Canada, particularly at the end of their life.
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Affiliation(s)
- Kimberley Widger
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont.
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Peter Tanuseputro
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Katherine E Nelson
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Adam Rapoport
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Hsien Seow
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Harold Siden
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Chris Vadeboncoeur
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
| | - Sumit Gupta
- Lawrence S. Bloomberg Faculty of Nursing (Widger, Brennenstuhl), University of Toronto; Hospital for Sick Children (Widger, Nelson, Rapoport, Gupta), Toronto, Ont.; Ottawa Hospital Research Institute (Tanuseputro); Department of Medicine (Tanuseputro), University of Ottawa; Bruyère Research Institute (Tanuseputro), Ottawa, Ont.; Emily's House Children's Hospice (Rapoport), Toronto, Ont.; McMaster University (Seow), Hamilton, Ont.; BC Children's Hospital (Siden); Canuck Place Children's Hospice (Siden), Vancouver, BC; Children's Hospital of Eastern Ontario (Vadeboncoeur); Roger Neilson House (Vadeboncoeur), Ottawa, Ont
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4
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Zimmermann K, Simon M, Scheinemann K, Tinner Oehler EM, Widler M, Keller S, Fink G, Mitterer S, Gerber AK, von Felten S, Bergstraesser E. Specialised Paediatric PAlliativE CaRe: Assessing family, healthcare professionals and health system outcomes in a multi-site context of various care settings: SPhAERA study protocol. BMC Palliat Care 2022; 21:188. [PMID: 36324132 PMCID: PMC9628037 DOI: 10.1186/s12904-022-01089-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The number of children and adolescents living with life-limiting conditions and potentially in need for specialised paediatric palliative care (SPPC) is rising. Ideally, a specialised multiprofessional team responds to the complex healthcare needs of children and their families. The questions of, how SPPC is beneficial, for whom, and under what circumstances, remain largely unanswered in the current literature. This study's overall target is to evaluate the effectiveness of a SPPC programme in Switzerland with respect to its potential to improve patient-, family-, health professional-, and healthcare-related outcomes. METHODS This comparative effectiveness study applies a quasi-experimental design exploring the effectiveness of SPPC as a complex intervention at one treatment site in comparison with routine care provided in a generalised PPC environment at three comparison sites. As the key goal of palliative care, quality of life - assessed at the level of the patient-, the family- and the healthcare professional - will be the main outcome of this comparative effectiveness research. Other clinical, service, and economic outcomes will include patient symptom severity and distress, parental grief processes, healthcare resource utilisation and costs, direct and indirect health-related expenditure, place of death, and introduction of SPPC. Data will be mainly collected through questionnaire surveys and chart analysis. DISCUSSION The need for SPPC has been demonstrated through numerous epidemiological and observational studies. However, in a healthcare environment focused on curative treatment and struggling with limited resources, the lack of evidence contributes to a lack of acceptance and financing of SPPC which is a major barrier against its sustainability. This study will contribute to current knowledge by reporting individual and child level outcomes at the family level and by collecting detailed contextual information on healthcare provision. We hope that the results of this study can help guiding the expansion and sustainability of SPPC and improve the quality of care for children with life-limiting conditions and their families internationally. TRIAL REGISTRATION Registered prospectively on ClinicalTrials.gov on January 22, 2020. NCT04236180 PROTOCOL VERSION: Amendment 2, March 01, 2021.
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Affiliation(s)
- Karin Zimmermann
- Paediatric Palliative Care and Children's Research Center CRC, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Michael Simon
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Katrin Scheinemann
- grid.413357.70000 0000 8704 3732Division of Pediatric Oncology – Hematology and Palliative Care, Kinderspital, Kantonsspital Aarau AG, Tellstrasse 25, 5001 Aarau, Switzerland ,grid.449852.60000 0001 1456 7938Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland ,grid.422356.40000 0004 0634 5667Department of Pediatrics, McMaster Children’s Hospital and University, Hamilton, Canada
| | - Eva Maria Tinner Oehler
- grid.411656.10000 0004 0479 0855Division of Pediatric Heamtology and Oncology, Paediatric Palliative Care, Children’s Hospital, Inselspital, Universitätsspital Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Michèle Widler
- grid.412347.70000 0004 0509 0981Paediatric Palliative Care, Children’s Hospital Basel, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Simone Keller
- grid.411656.10000 0004 0479 0855Paediatric Palliative Care, Children’s Hospital, Inselspital, Universitätsspital Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Günther Fink
- grid.416786.a0000 0004 0587 0574Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - Stefan Mitterer
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Anne-Kathrin Gerber
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Stefanie von Felten
- grid.6612.30000 0004 1937 0642Clinical Trial Unit, Department of Clinical Research, University of Basel, Basel, Switzerland ,grid.7400.30000 0004 1937 0650Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Eva Bergstraesser
- grid.412341.10000 0001 0726 4330Paediatric Palliative Care and Children’s Research Center CRC, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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