Application of Instrumental Variable Analysis in Pediatric End-of-Life Research: A Case Study.
Radion Svynarenko, Melanie J Cozad, Jennifer W Mack and 3 others
PMID 36964702WHAT IT FOUND
Pediatric hospice patients in concurrent care had a 19.3% decrease in one-day enrollment compared with standard care, but this was an analysis of existing records, not a trial.
Key findings
01The case study used Medicaid hospice records for 18,152 pediatric patients under 21 years of age.
02In the instrumental variable model, concurrent hospice care was associated with a 19.3% decrease in one-day hospice enrollment.
03A simple logistic model did not show a statistically significant effect for concurrent hospice care on one-day enrollment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a methodological illustration using existing records, not a randomized trial. The instrumental variable was not a perfect randomizer because children seeing multiple providers differed in health conditions and region. The simple logistic model did not find a significant effect, so the clinical result is not settled. The paper does not report patient or family outcomes such as symptom control or quality of life.
Declared interests
The authors report nothing to disclose. The publication types list NIH extramural research support.
The easy way to misread this
Do not conclude that concurrent hospice care causes better end-of-life care for children. The 19.3% decrease came from an observational instrumental variable analysis, and the simple logistic model did not show a significant effect.