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Svynarenko R, Huang G, Keim-Malpass J, Cozad MJ, Qualls KA, Stone Sharp W, Kirkland DA, Lindley LC. A Comparison of Hospice Care Utilization Between Rural and Urban Children in Appalachia: A Geographic Information Systems Analysis. Am J Hosp Palliat Care 2024; 41:288-294. [PMID: 37115718 PMCID: PMC10826679 DOI: 10.1177/10499091231173415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Long driving times from hospice providers to patients lead to poor quality of care, which may exacerbate in rural and highly isolated areas of Appalachia. This study aimed to investigate geographic patterns of pediatric hospice care across Appalachia. Using person-level Medicaid claims of 1,788 pediatric hospice enrollees who resided in the Appalachian Region between 2011 and 2013. A database of boundaries of Appalachian counties, postal addresses of hospices, and population-weighted county centroids of residences of hospice enrollees driving times from the nearest hospices were calculated. A choropleth map was created to visualize rural/urban differences in receiving hospice care. The average driving time from hospice to child residence was 28 minutes (SD = 26). The longest driving time was in Eastern Kentucky-126 minutes (SD = 32), and the shortest was in South Carolina-11 min (SD = 9.1). The most significant differences in driving times between rural and urban counties were found in Virginia 28 (SD = 7.5) and 5 minutes (SD = 0), respectively, Tennessee-43 (SD = 28) and 8 minutes (SD = 7), respectively; and West Virginia-49 (SD = 30) and 12 minutes (SD = 4), respectively. Many pediatric hospice patients reside in isolated counties with long driving times from the nearest hospices. State-level policies should be developed to reduce driving times from hospice providers.
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Affiliation(s)
| | - Guoping Huang
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | | | - Melanie J Cozad
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kerri A Qualls
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | | | - Deb A Kirkland
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | - Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, TN, USA
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Qualls KA, Svynarenko R, Cozad MJ, Keim-Malpass J, Huang G, Lindley LC. Geographic Information Systems Utilization in Pediatric End-of-Life Research: A Scoping Review. Am J Hosp Palliat Care 2024; 41:216-227. [PMID: 36960618 PMCID: PMC10825508 DOI: 10.1177/10499091231165276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
Currently, little is known about how geographic information systems (GIS) has been utilized to study end-of-life care in pediatric populations. The purpose of this review was to collect and examine the existing evidence on how GIS methods have been used in pediatric end-of-life research over the last 20 years. Scoping review method was used to summarize existing evidence and inform research methods and clinical practice was used. The Preferred Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA) was utilized. The search resulted in a final set of 17 articles. Most studies created maps for data visualization and used ArcGIS as the primary software for analysis. The scoping review revealed that GIS methodology has been limited to mapping, but that there is a significant opportunity to expand the use of this methodology for pediatric end-of-life care research.
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Affiliation(s)
- Kerri A Qualls
- College of Nursing, University of Tennessee, Knoxville, TN, USA
| | | | - Melanie J Cozad
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Guoping Huang
- Spatial Sciences Center, University of Southern California, Los Angeles, CA, USA
| | - Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, TN, USA
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Abstract
OBJECTIVE The goal of this study was to compare rural and urban pediatric hospice patients in Appalachia. METHODS Using a retrospective, nonexperimental design, we sought to compare characteristics of Appalachian rural and urban children younger than 21 years enrolled in the Medicaid hospice benefit. Descriptive statistics were calculated on the demographic, hospice, and clinical characteristics of children from Appalachia. Comparisons were calculated using Pearson χ2 for proportions and the Student t test for means. RESULTS Less than half of the 1788 Appalachian children admitted to hospice care resided in rural areas (40%). Compared with children in urban areas of Appalachia, rural children were significantly younger (8 years vs 9.5 years) and more often had a complex chronic condition (56.0% vs 35.1%) and comorbidities (38.5% vs 17.0%) with technology dependence (32.6% vs 17.0%). Children in rural Appalachian were commonly from communities in the southern region of Appalachia (27.9% vs <10.0%), with median household incomes <$50,000/year (96.7% vs 22.4%). Significant differences were present in clinical care between rural and urban Appalachian children. Rural children had longer lengths of stay in hospice care (38 days vs 11 days) and were less likely to use the emergency department during hospice admission (19.0% vs 43.0%). These children more often visited their primary care provider (49.9% vs 31.3%) and sought care for symptoms from nonhospice providers (18.1% vs 10.0%) while admitted to hospice. CONCLUSIONS Our results suggest that children admitted to hospice care in rural versus urban Appalachia have distinct characteristics. Rural children are admitted to hospice care with significant medical complexities and reside in areas of poverty. Hospice care for rural children suggests a continuity of care with longer hospice stays and fewer transitions to the emergency department; however, the potential for care fragmentation is present, with frequent visits to primary care and nonhospice providers for symptom management. Understanding the unique characteristics of children in Appalachia may be essential for advancing knowledge and care for these children at the end of life. Future research examining geographic variation in hospice care in Appalachia is warranted.
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Affiliation(s)
- Mary Lou Clark Fornehed
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Radion Svynarenko
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Jessica Keim-Malpass
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Melanie J Cozad
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Kerri A Qualls
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Whitney L Stone
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
| | - Lisa C Lindley
- From the Whitson-Hester School of Nursing, Tennessee Technological University, Cookeville, the College of Nursing, University of Tennessee, Knoxville, the School of Nursing, University of Virginia, Charlottesville, and the Department of Health Services Policy and Management, Center for Effectiveness Research in Orthopedics, University of South Carolina, Columbia
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