Comparison of Pediatric and Adult Hospice Patients Using Electronic Medical Record Data from Nine Hospices in the United States, 2008–2012

In the Journal of Palliative Medicine, David Casarett and colleagues from Penn Medicine look at pediatric and adult hospice patients and analyze differences in their characteristics and outcomes. In the study of over 126,000 hospice patients, children (18 years of age or younger) make up less than one percent of the hospice population. The authors posit that characteristics and needs of children in hospice are very different to that of adults. Despite this, pediatric patients are in general receiving services designed for adults, with only one third of hospice agencies running formal pediatric programs. Looking at retrospective cohort data, the authors find that children in hospice are less likely to have cancer, less likely to need oxygen, and less likely to have a do-not-resuscitate order. Children in hospice are more likely to have an enteral feeding tube. The data shows that average hospice length of stay for pediatric patients is longer than that of adults. Children are more likely to leave hospice care, but among patients who died while enrolled in hospice, pediatric patients are more likely to die at home. The study has important implications for hospice managers and caregivers, especially those that do not have formal pediatric programs in place.