UBC Theses and Dissertations
The influence of a pediatric palliative care program on health care utilization and costs Conte, Tania
Pediatric palliative care program (PPCP) is believed to increase system efficiency. British Columbia (BC) relies on a free-standing hospice-based PPCP, and its effects on health care utilization and costs remain an outstanding question. This study aimed to gather evidence in a combined analysis of data from literature and BC PPCP. A systematic review was conducted through an electronic search of Medline, Embase, CINAHL, LILACS, and grey literature. Comparative studies reporting admissions, length of stay, and health care costs between PPCP users and usual care were included. Additionally, a similar comparison was applied to the data from BC PPCP using a retrospective matched-pairs cohort design (matched by ICD code and age at death) with a 3-year observational period prior to death. Data were obtained from Canuck Place Children’s Hospice and BC Children’s Hospital databases, and complemented by estimates from Canadian Institute for Health Information. A cost impact of the overall inpatient care provided by the hospice was presented. The review did not demonstrate a decrease in utilization by PPCP users yet suggested a shift to other health care settings, and potential cost saving in the Canadian context (1 article). The cohort study (n=11 pairs), suggests that children in both groups had similar upward trends in inpatient utilization and cost. However, PPCP users showed more inpatient care in the last year of life (especially critical care in the last 2 months), compared to their controls and to the period prior to referral. Post-referral, a shift in health care setting utilization from hospital to hospice was observed, representing approximately 50% of the costs. Without this shift PPCP users would have cost 32% more with a median monthly increment of $7,163 per child. All inpatient care provided by the hospice in the fiscal year 2011-2012 represented a potential cost saving ranging from approximately $1.1M to $4.3M. The findings of this study suggest that PPCP users may present higher health care needs, and that the shift of inpatient care to the hospice optimized resource use, offering a more holistic approach to EOL care, relieving hospital resources to meet other demands.
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