Pediatric palliative care underutilized in the United States

Pediatric palliative care (PPC) is underutilized for children and families in US hospitals, according to a recent study.

PPC is used to provide children suffering from life-impacting illnesses with specialized treatment, improving their quality of life. Since its formation, PCP has been recognized as a subspecialty in medicine, but has still not been properly implemented in children’s hospitals.

Presence and function of PPCs has mostly been self-reported. If given a proper overview, PPCs could be empowered to improve resources and access. To analyze the presence of PPCs, investigators conducted a study gathering public data from the Children’s Hospital Association (CHA).

The CHA conducted a survey across 231 hospitals in the United States about programs and services offered in 2020. Questions were phrased to create binary responses, such as whether a specific program was available at the hospital being surveyed. Survey results were aggregated and blinded.

Along with obtaining demographic data on hospitals, the study team created 4 domains: operational, missional, educational, and financial. The operations domain included characteristics such as trauma level, long-term care facility, and home health. The missional domain included characteristics such as accreditation status, family advisory board, and family resource center.

Accreditation Council for Graduate Medical Educationresidency programor American Medical Association affiliation were educational characteristics, while participation in Accountable Care Organization (ACO) and designation as a federally qualified health center were financial characteristics. Data was summarized and analyzed using PC SAS version 9.4.

Of the 231 hospitals which received survey requests, 148 submitted information on the 2020 fiscal year. A PPC was reported in 119 of these, with 8 of 50 states presenting 5 or more PPC programs. PPC programs were more often seen in Midwest regions, followed by Northeast regions, then South regions, and finally West regions. These changes were not significant enough for geographical location to be considered a factor on PPC prevalence.

PPC programs were more likely to be seen in free-standing children’s hospitals compared to pediatric settings in adult hospitals. The median number of staffed beds in settings with PPC programs was 185, compared to a median 49 staffed beds in settings without PPC programs.

Access to hospice services, which is correlated with PPC presence, was reported in less than half of respondent facilities. PPC also correlated with NICU designation, home health services, Magnet recognition, family advisory boards, social determinant of health, and family resource centers. PPC access was also associated with ACO designation.

The study found that 1 in 5 hospitals are lacking access to PPC programs. Though access to PPC was listed is key criterion for hospital quality by US News and World Report in 2006, access is still limited. Investigators concluded that the expansion of PPC access is an urgent priority.

Reference

Weaver MS, Shostrom VK, Kaye EC, Keegan A, Lindley LC. Palliative care programs in children’s hospitals. Pediatrics. 2022;150(4). doi:10.1542/peds.2022-057872