Effectiveness of end-of-life strategies to improve pediatric health outcomes and reduce disparities in rural Appalachia

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Project Summary Rural Appalachia has struggled with health and healthcare access for more than a century. For children, lack of access to healthcare services starts at birth with limited prenatal care resources and continues to end of life with restricted access to pediatric hospice. The main objective of this study is to investigate the effect of expanding access to pediatric hospice care (concurrent care) to reduce rural/urban disparities in child and adolescent health outcomes (symptom management, care continuity, and costs). To do this, we will obtain, link, and analyze data from a variety of sources including 2011-2014 Medicaid data, U.S. Census, and hospice provider files. We will employ geographic information systems and comparative effectiveness data analytic methods, in which we will control for patient/family, hospice provider, and community characteristics. A unique aspect of our proposed study is the use of mapping techniques to visualize rural/urban disparities in access to pediatric hospice care in Appalachia. By examining these data, we will be able to assess impact of concurrent care on rural/urban disparities and health outcomes in a significantly underserved populations. As the health of children and adolescents continues to decline in the Appalachian region, this information is of major importance to clinicians, policy-makers, and families. This line of investigation is expected to ultimately improve the quality care for children, adolescents, and their families at end of life in Appalachia.