Home-Based Pediatric Hospice and Palliative Care Provider Visits: Effects on Healthcare Utilization.

OBJECTIVE: This hypothesis-generating study sought to assess the impact of home-based hospice and palliative care (HBHPC) provider home visits (HV) on healthcare utilization.

STUDY DESIGN: Retrospective review of individuals ages 1 month to 21 years receiving an in-person HBHPC provider (MD/DO or APN) home visit through two HBHPC programs in the Midwest from 1/1/2013 through 12/31/2018. Descriptive statistics were calculated for healthcare utilization variables. Paired t-test or Wilcoxon signed-rank test compared the changes in healthcare utilization the year prior to and year after initial provider home visits.

RESULTS: The cohort included 195 individuals (49% female), with diagnoses comprised of 49% neurologic, 30% congenital chromosomal, 11% oncologic, 7% cardiac, and 3% other. After implementation of HBHPC services, these patients showed reductions in median [IQR] number of ICU days (before HV 12 [4, 37] after HV 0 [0, 8], p<0.001); inpatient admissions (before HV 1 [1, 3] after HV 1 [0, 2], p=0.005); and number of inpatient days (before HV 5 [1, 19] after HV 2 [0, 8], p=0.009). There was an increase in clinically relevant phone calls (CRPC) to the HBHPC team (before HV 1 [0, 4] vs after HV 4 [1, 7], p<0.001) and calls to the HBHPC team before emergency department visits (before HV 0 [0, 0] vs after HV 1 [1, 2], p<0.001).

CONCLUSION: HBHPC provider home visits were associated with decreased inpatient admissions, hospital days, and ICU days, and increased CRPC and phone calls prior to emergency department visit. These findings indicate that HBHPC HV may contribute to decreased inpatient utilization and increased utilization of the HBHPC team.