End-of-Life Transitions and Hospice Utilization for Adolescents: Does Having a Usual Source of Care Matter?

The study used California fee-for-service Medicaid and CHIP claims, excluded Medicaid managed care, and may not apply to adolescents outside California or with private insurance only. Usual source of primary care did not capture all sources of usual care, including nurse coordination. The analysis was pooled and cross-sectional over the last year of life, so it cannot show that usual source caused outcomes; reverse causation is possible if sicker adolescents kept primary care contact. Data were truncated to the last year, although less than 0.5% of adolescents may have had prior-year hospice claims. The sample was limited to adolescents aged 15 to 20. The claims data did not allow examination of specific cancer diagnoses or other clinical details not captured in the dataset.

The authors declared no conflict of interest.

Do not conclude that assigning a usual primary care provider improves end-of-life care or reduces fragmentation. This observational study found that usual source was associated with more hospice enrollment and longer stays, but also with more end-of-life transitions, and it cannot rule out reverse causation.