Background. Of the 54,000 children, who die in the US, many lack access to hospice care. As terminally ill children increasingly return home to die, little is known about the hospices that provide care for children and what factors may influence whether care is provided.
Objective. To understand the institutional and resource factors that may influence the provision of hospice care for children, while controlling for organizational and market factors.
Methods. This study used a retrospective, longitudinal design. The main data source was the California OSHPD –State Utilization Data File of Home Health Agency and Hospice Facilities 2002 to 2008. After applying inclusion and exclusion criteria, the sample size was 1,368 hospice observations over 7 years. Drawing on institutional and resource dependence theory, this study used generalized estimating equations to examine the institutional and resource pressures associated with provision of hospice care. Interaction terms were included to assess the moderating effect of resource pressures on the relationship between institutional pressures and provision of care.
Results. The percentage of hospices providing care for children significantly declined from 2002 to 2008. This study found that provision of hospice care for children was positively associated with membership in a professional group, and was negatively related to small-sized hospice, medium-sized hospices, and increasing competition. There was no effect of accreditation, organization leader, or other income on providing pediatric hospice care. In addition, small size attenuated the accreditation-provision relationship and medium size magnified the membership-provision relationship.
Conclusions. The findings of this study provide specific information on the institutional and resource pressures exerted on hospices in the provision of care for children, and suggests organizational and policy level strategies to improve access to and delivery of hospice care for children.
|Advisor:||Mark, Barbara A.|
|Commitee:||Domino, Marisa, Jacobson Vann, Julie, Lee, Shoou-Yih, Song, Mi-Kyung|
|School:||The University of North Carolina at Chapel Hill|
|School Location:||United States -- North Carolina|
|Source:||DAI-B 73/01, Dissertation Abstracts International|
|Keywords:||Children, End of life care, Health care organizations, Health services, Hospice care, Pediatric hospice care|
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