The Affordable Care Act allowed children enrolled in Medicaid to receive curative care concurrently with hospice care. This is a novel approach to end-of-life care, and little is known about the intensity of utilization of non-hospice health care services among children with cancer enrolled in concurrent hospice care.

Objective: To investigate patterns of utilization of non-hospice health care services among children with cancer enrolled in concurrent hospice care.

Methods: This study was a retrospective cohort analysis of Medicaid claims data from 862 pediatric cancer patients enrolled in concurrent hospice care between 2011 and 2013. Data were analyzed using descriptive statistics and latent class analysis.

Results: Children in the sample used 120,388 services, including inpatient and outpatient hospital services, labs & x-rays, durable medical equipment, medications, and others. Based on the intensity of utilization of these services, two classes of children were identified, with moderate (57.49%) and high-intensity (42.50%) care needs. Children who received high-intensity care were more likely to have comorbidities, mental and behavioral conditions, technology dependence, and were less likely to have solid tumors.

Conclusions: Non-hospice health care services cluster together in two distinctive classes providing critical insight into the complexity of the health care needs of children with cancer.

Implications for Practice: Identification of children with moderate and high-intensity care needs may help health care professionals to provide better end-of-life care to children with cancer enrolled in concurrent hospice care.

Key words: concurrent hospice care, latent class analysis, pediatric hospice care, pediatric oncology

Lisa Lindley PhD, RN, FPCN, FAAN

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