In 2010, forgoing curative therapies were removed as a hospice eligibility criterion for children through section 2302 of the Patient Protection and Affordable Care Act called Concurrent Care for Children. Given that concurrent care is a federally mandated option for children and their families, no review of the science has been conducted. The purpose of this study was to systematically collect the evidence on concurrent hospice care, critically appraise the evidence, and identify areas for future nursing research. Of the 186 articles identified for review, 14 met the inclusion and exclusion criteria. Studies in this review described concurrent hospice care from a variety of perspectives: policy, legal, and ethics. However, only 1 article evaluated the impact of concurrent hospice care on outcomes, whereas several studies explained clinical and state-level implementation. There is a need for further studies that move beyond conceptualization and generate baseline and outcomes data. Understanding the effectiveness of concurrent hospice care might provide important information for future nursing research. The approaches used to disseminate and implement concurrent hospice care at state, provider, and family levels should be explored.

Inconsistency in identifying rural hospices has biased research findings and policy analysis. The purpose of this study was to conduct a comprehensive evaluation of eight rural-urban classifications against the gold standard of the Office of Budget and Management (OMB) to determine the utility of alternative measures in hospice research. These classifications included: Urban-Rural Classification Scheme for Counties (URCSC), Urban Influence Codes (UIC), Rural-Urban Continuum Code (RUCC), Federal Office of Rural Health Policy (FORHP), Index of Relative Rurality (IRR), the U.S. Census Bureau, Rural-Urban Commuting Area codes (RUCA), and Frontier and Remote (FAR). The last and the U.S. Census Bureau classified the smallest number of hospices; URCSC, UIC, and RUCC were indistinguishable from the OMB; and RUCA, IRR, and FORHP classified as rural the largest number of hospices. The latter three classifications also had good agreement with the OMB and therefore can be recommended for use instead of the OMB.

The 2010 Patient Protection and Affordable Care Act (ACA) mandated landmark hospice care legislation for children at end of life. Little is known about the impact of pediatric concurrent hospice care. The purpose of this study was to examine the effect of pediatric concurrent vs standard hospice care on end-of-life care continuity among Medicaid beneficiaries. Using national Medicaid data, we conducted a quasi-experimental designed study to estimate the effect of concurrent vs standard hospice care to improve end-of-life care continuity for children. Care continuity (i.e., hospice length of stay, hospice disenrollment, emergency room transition, and inpatient transition) was measured via claims data. Exposures were concurrent hospice vs standard hospice care. Using instrumental variable analysis, the effectiveness of exposures on care continuity was compared. Concurrent hospice care affected care continuity. It resulted in longer lengths of stays in hospice (β = 2.76, P < .001) and reduced hospice live discharges (β = −2.80, P < .05), compared to standard hospice care. Concurrent care was not effective at reducing emergency room (β = 2.09, P < .001) or inpatient care (β = .007, P < .05) transitions during hospice enrollment. Our study provides critical insight into the quality of care delivered for children at end of life. These findings have policy implications.

Background: Children at end of life have unique and complex care needs. Although there is increasing evidence about pediatric concurrent hospice care, the health care services received while in hospice have not received sufficient attention. Objectives: To examine the health care services, unique clusters of health care services, and characteristics of the children in the clusters. Methods: Multiple data sources were used including national Medicaid claims data. Children under 21years in pediatric concurrent hospice care were included. Using Medicaid categories assigned to claims, health care services were distributed across 20 categories. Latent class analysis was used to identify clusters of health care services. Demographic profiles of the clusters were created. Results: The 6,243 children in the study generated approximately 500,0000 non-hospice, health care service claims while enrolled in hospice care. We identified 3 unique classes of health care services use: low (61.1%), moderate (18.1%), and high (20.8%) intensity. The children in the 3 classes exhibited unique demographic profiles. Conclusions: Health care services cluster together in unique fashion with distinct patterns among children in concurrent hospice care. The findings suggest that concurrent hospice care is not a 1-size-fit all solution for children. Concurrent hospice care may be customized and require attention to care coordination to ensure high-quality care.