Children with intellectual disability and hospice utilization.
Lisa C Lindley, Mari Beth Colman, John T Meadows
PMID 28260997WHAT IT FOUND
Children with moderate to profound intellectual disability were less likely to use hospice and stayed less time, often less than a day.
When they also had comorbidities, they were more likely to enroll. Short stays leave little time for nurses to provide end-of-life care.
Key findings
01Children with intellectual disability had lower odds of hospice enrollment (OR=0.12, p <0.01).
02Children with intellectual disability had fewer hospice days (IRR=0.06, P <0.05), and among those who enrolled, average stay was less than a day.
03When children had both intellectual disability and comorbidities, they were almost 8 times more likely to enroll (OR=7.83, p <0.05).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The findings apply only to children in the California Medicaid population who had a complex chronic condition and died between 2009 and 2010. Only the last calendar year of life was included, so hospice length of stay may have been truncated or under-reported. The sample had a high percentage of non-Caucasian children, which may introduce selection bias. The claims data cannot explain why families did not enroll or whether they were satisfied with very short hospice stays. The data did not allow assessment of whether children with intellectual disability could participate in care decisions or understand death.
Declared interests
The authors reported no potential conflicts of interest.
The easy way to misread this
Do not conclude that intellectual disability itself causes low hospice use or that hospice is inappropriate for these children. The study reports associations from Medicaid claims, and children with intellectual disability plus comorbidities were more likely to enroll.