Costs of Care and Location of Death in Community-Based Pediatric Palliative Care

Abstract

<b><i>Background:</i></b> Children with complex chronic conditions (CCCs) are dying at home with increased frequency, yet the number of studies on the financial feasibility of community-based pediatric palliative care is limited. <b><i>Objective:</i></b> The objectives of this study were to (1) describe characteristics of patients who died in a community-based palliative care program and (2) evaluate cost differences associated with participant characteristics and location of death. <b><i>Design:</i></b> A retrospective cohort analysis of administrative and electronic medical record data was employed. <b><i>Setting/Subjects:</i></b> Children enrolled in the community-based pediatric palliative care program, CompassionNet, who died between 2008 and 2015 were included (<i>N</i> = 224). <b><i>Measurements:</i></b> Demographic data, program expense, and paid claims were extracted from an insurance provider database and clinical data from the electronic medical record. <b><i>Results:</i></b> Sixty-six (29%) of the children were <1 year old at death; 80 (36%) were 1-9 years old, and 78 (35%) were 10-22 years old. Malignancy was the most common primary CCC diagnosis for the 158 children/adolescents (<i>n</i> = 89, 56%), whereas neuromuscular conditions (<i>n</i> = 20, 30%) were most frequent for infants. Death at home occurred 21% of the time for infants, 48% for children of ages 1-9 years, and 46% for children of ages 10-22 years. The mean total cost in the final year of life for pediatric patients was significantly related to location of death, a malignancy diagnosis, and participation in Medicaid. The largest estimated difference was between costs of care associated with death at home ($121,111) versus death in the hospital ($200,050). <b><i>Conclusions:</i></b> Multidisciplinary community-based pediatric palliative care teams provide the opportunity for a home death to be realized as desired. Significant cost differences associated with location of death may support program replication and sustainability.