Impact of Palliative Care on Healthcare Outcomes in Complex Chronic Pediatric Patients




Farias, Kimberly
Price, Rachael
Dang, The
Lawrence, Katie
Hoeft, Alice
Hamby, Tyler


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Purpose: Palliative Care (PC) has been correlated with decreased length of stay and cost of care and with fewer ICU visits, administered medications, and medical interventions. Additionally, research has correlated PC with better quality of life, quality of care, continuity of care, and management of family needs. Through patient and family health care education, PC services are able to reduce hospitalizations and normalize the patients’ lives as permitted by their medical conditions. The purpose of this research was to determine whether PC has had a positive impact on the care received by pediatric patients with complex chronic conditions at a single institution. Methods: A retrospective investigation was conducted on all pediatric patients with complex chronic conditions who died at Cook Children’s Medical Center between January 2013 and December 2014. For each patient, demographics, diseases, number of hospitalizations, and age at death were abstracted. For each patient visit, data collected included PC involvement, number of medications, length of stay, and whether a MOST form (medical orders for scope of treatment) was completed. Results: There were 43 total patients in this study (49% male), and 12 patients had at least 1 PC visit. Patients who had at least 1 PC visit did not differ from patients with no PC visits in demographic variables, disease, age at death, or in the rate of MOST orders, but they had greater number of hospitalizations, longer lengths of stay, and less medications per day than non-PC patients. Conclusions: The finding that PC patients had a smaller average number of medications per day could be due to the healthcare team taking into account the total effect of polypharmacy on a patient, and then selecting only the most necessary medications. The finding that PC patients had longer and more frequent hospitalizations could be due to the late initiation of PC, instead of PC’s intended early application. Lack of knowledge of what PC services offers to patients, and a misconstrued view of PC services could be contributing factors to the delay in start. Frequently providers view PC as end of life care only, so its late initiation most likely biased the results. Increasing providers’ knowledge of the services that PC has to offer could increase its early initiation with patients and possibly decrease the length of stay and frequency of hospitalizations.