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. 2024 Mar;41(3):288-294.
doi: 10.1177/10499091231173415. Epub 2023 Apr 28.

A Comparison of Hospice Care Utilization Between Rural and Urban Children in Appalachia: A Geographic Information Systems Analysis

Radion Svynarenko  1 , Guoping Huang  2 , Jessica Keim-Malpass  3 , Melanie J Cozad  4 , Kerri A Qualls  1 , Whitney Stone Sharp  1 , Deb A Kirkland  1 , Lisa C Lindley  1
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A Comparison of Hospice Care Utilization Between Rural and Urban Children in Appalachia: A Geographic Information Systems Analysis

Radion Svynarenko et al. Am J Hosp Palliat Care. 2024 Mar.

Abstract

Long driving times from hospice providers to patients lead to poor quality of care, which may exacerbate in rural and highly isolated areas of Appalachia. This study aimed to investigate geographic patterns of pediatric hospice care across Appalachia. Using person-level Medicaid claims of 1,788 pediatric hospice enrollees who resided in the Appalachian Region between 2011 and 2013. A database of boundaries of Appalachian counties, postal addresses of hospices, and population-weighted county centroids of residences of hospice enrollees driving times from the nearest hospices were calculated. A choropleth map was created to visualize rural/urban differences in receiving hospice care. The average driving time from hospice to child residence was 28 minutes (SD = 26). The longest driving time was in Eastern Kentucky-126 minutes (SD = 32), and the shortest was in South Carolina-11 min (SD = 9.1). The most significant differences in driving times between rural and urban counties were found in Virginia 28 (SD = 7.5) and 5 minutes (SD = 0), respectively, Tennessee-43 (SD = 28) and 8 minutes (SD = 7), respectively; and West Virginia-49 (SD = 30) and 12 minutes (SD = 4), respectively. Many pediatric hospice patients reside in isolated counties with long driving times from the nearest hospices. State-level policies should be developed to reduce driving times from hospice providers.

Keywords: ArcGIS; concurrent hospice care; medicaid; pediatric hospice care; rural hospice care; spatial analysis.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Map of Driving Times from Hospices to Children Residing in Rural and Urban Counties in the Appalachian Region.
See this image and copyright information in PMC

References

    1. Thakrar AP, Forrest AD, Maltenfort MG, Forrest CB. Child mortality in the US and 19 OECD comparator nations: A 50-year time-trend analysis. Health Aff (Millwood) 2018;37(1):140–149. doi:10.1377/hlthaff.2017.0767 - DOI - PubMed
    1. Xu J, Murphy SL, Kochanek KD, Bastian B, Arias E. Deaths: Final data for 2016. Natl Vital Stat Rep 2018;67(5):1–76. - PubMed
    1. World Health Organization. Cancer Pain Relief and Palliative Care in Children World Health Organization; 1998.
    1. Committee on Bioethics and Committee on Hospital Care. Palliative care for children. Pediatrics 2000;106(2):351–357. doi:10.1542/peds.106.2.351 - DOI - PubMed
    1. National Hospice and Palliative Care Organization (NHPCO). NHPCO Facts and Figures NHPCO; 2022. Accessed July 31, 2022. Available at: https://www.nhpco.org/factsfigures/