College of Nursing, University of Tennessee, Knoxville, TN, USA.
School of Nursing, University of Maryland, Baltimore, MD, USA.
Am J Hosp Palliat Care. 2022 Mar;39(3):282-288. doi: 10.1177/10499091211018661. Epub 2021 May 25.
Children at end of life have unique and complex care needs. Although there is increasing evidence about pediatric concurrent hospice care, the health care services received while in hospice have not received sufficient attention.
To examine the health care services, unique clusters of health care services, and characteristics of the children in the clusters.
Multiple data sources were used including national Medicaid claims data. Children under 21years in pediatric concurrent hospice care were included. Using Medicaid categories assigned to claims, health care services were distributed across 20 categories. Latent class analysis was used to identify clusters of health care services. Demographic profiles of the clusters were created.
The 6,243 children in the study generated approximately 500,0000 non-hospice, health care service claims while enrolled in hospice care. We identified 3 unique classes of health care services use: low (61.1%), moderate (18.1%), and high (20.8%) intensity. The children in the 3 classes exhibited unique demographic profiles.
Health care services cluster together in unique fashion with distinct patterns among children in concurrent hospice care. The findings suggest that concurrent hospice care is not a 1-size-fit all solution for children. Concurrent hospice care may be customized and require attention to care coordination to ensure high-quality care.
生命末期的儿童有独特且复杂的护理需求。尽管越来越多的证据表明儿科同时接受临终关怀，但在临终关怀期间接受的医疗保健服务尚未得到足够重视。
研究儿童同时接受临终关怀时的医疗保健服务、独特的医疗保健服务集群以及这些集群中儿童的特征。
使用了多种数据源，包括国家医疗补助（Medicaid）索赔数据。研究纳入了 21 岁以下同时接受儿科临终关怀的儿童。根据索赔分配的 Medicaid 类别，医疗保健服务被分配到 20 个类别中。采用潜在类别分析（Latent Class Analysis）识别医疗保健服务集群。创建了集群的人口统计学特征。
这项研究中的 6243 名儿童在接受临终关怀期间，大约产生了 50 万份非临终关怀医疗保健服务索赔。我们确定了 3 种独特的医疗保健服务使用类别：低（61.1%）、中（18.1%）和高（20.8%）强度。这 3 个类别的儿童表现出独特的人口统计学特征。
医疗保健服务以独特的方式聚集在一起，同时接受临终关怀的儿童之间存在明显的模式差异。研究结果表明，同时接受临终关怀并不是所有儿童的一刀切解决方案。临终关怀可以定制，并需要关注护理协调，以确保高质量的护理。
