Geographic Variation in California Pediatric Hospice Care for Children and Adolescents: 2007-2010

Objective: To map and describe the geographic distribution of pediatric hospice care need versus supply in California over a 4-year time period (2007-2010). Methods: Multiple databases were used for this descriptive longitudinal study. The sample consisted of 2036 children and adolescent decedents and 136 pediatric hospice providers. Geocoded data were used to create the primary variables of interest for this study—need and supply of pediatric hospice care. Geographic information systems were used to create heat maps for analysis. Results: Almost 90% of the children and adolescents had a potential need for hospice care, whereas more than 10% had a realized need. The highest density of potential need was found in the areas surrounding Los Angeles. The areas surrounding the metropolitan communities of Los Angeles and San Diego had the highest density of realized hospice care need. Sensitivity analysis revealed neighborhood-level differences in potential and realized need in the Los Angeles area. Over 30 pediatric hospice providers supplied care to the Los Angeles and San Diego areas. Conclusion: There were distinctive geographic patterns of potential and realized need with high density of potential and realized need in Los Angeles and high density of realized need in the San Diego area. The supply of pediatric hospice care generally matched the needs of children and adolescents. Future research should continue to explore the needs of children and adolescents at end of life at the neighborhood level, especially in large metropolitan areas.