Medical complexity and concurrent hospice care: A national study of Medicaid children from 2011 to 2013.
Jessica Keim-Malpass, Melanie J Cozad, Radion Svynarenko and 2 others
PMID 33811725WHAT IT FOUND
Medical complexity was not related to concurrent hospice use among 18,145 Medicaid children.
Overall, 34% used concurrent care. Children needing technology, with multiple complex chronic conditions, or mental/behavioral disorders were more likely to use concurrent care.
Key findings
01The final cohort included 18,145 Medicaid pediatric decedents, and 34% used concurrent hospice care during 2011 to 2013.
02Although 13% met all four medical complexity criteria, medical complexity was not related to concurrent versus standard hospice care.
03Children with a complex chronic condition were less likely to use concurrent care, while children needing technology, having multiple complex chronic conditions, or mental or behavioral disorders were more likely.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective and non-experimental, so it cannot show that any factor caused hospice type. Unobserved confounding may have biased estimates. The sample was Medicaid children only, so results cannot be generalized to children with other insurance. Data were from 2011 to 2013, and provider, family, and cultural views may have changed since then. The outcome was created from claims procedure and revenue codes, not direct observation. In the waiver-service sensitivity analysis, technology dependence was not significantly related to concurrent care.
Declared interests
No conflicts-of-interest statement was provided in the supplied text. The paper is listed as supported by NIH extramural research.
The easy way to misread this
Do not read the higher odds for technology dependence, multiple complex chronic conditions, or mental or behavioral disorders as proof that concurrent care improves end-of-life outcomes. The study observed which hospice model was used, not patient or family outcomes, and overall medical complexity was not related to concurrent care.