Differences in Characteristics of Children with Cancer who Receive
Standard versus Concurrent Hospice Care
Abstract
Background: The provision of Section 2302 of the 2010 Patient Protection
and Affordable Care Act (ACA) allowed pediatric patients who are
enrolled in Medicaid to receive hospice care concurrently with curative
treatment (i.e., concurrent hospice care). Because it is a relatively
new model of care and very little is known about the characteristics of
children with cancer who receive it, the purpose of the current study
was to compare demographic, health, and community characteristics of
children who received standard hospice care versus concurrent hospice
care. Procedure: This study was a retrospective, comparison study with
national Medicaid files provided by the Center for Medicare and Medicaid
Services (CMS). The sample included 1,685 pediatric patients under the
age of 20 who were diagnosed with cancer, were enrolled in hospice
between 2011 and 2013, and received standard hospice care (n= 1,008) or
concurrent hospice care (n = 655). Results: Children of non-Caucasian
race with multiple complex chronic conditions, mental/behavioral health
problems technology dependence, and brain and orbital tumors, were more
likely to be enrolled in concurrent care than in standard hospice care.
The proportion of children enrolled in concurrent care versus standard
hospice care was larger in rural areas, low-income communities, and in
the Southern states. Conclusions: The enhanced uptake of concurrent care
by traditionally underserved populations is promising. Concurrent
hospice care, which allows for continued medical treatment and hospice
care, could enhance access to hospice within these populations by
offering a more blended model of care.