O2183: A Model for Delivery of Hospice Care via Telehealth Services

Purpose/Objectives: Pediatric hospice services are limited due to a lack of pediatric expertise, insurance coverage, and limited resources for the pediatric population. Our institution serves 8 counties in the South Florida Region and only 4 hospice institutions admit pediatric patients. Further, the patient population is unique with over one-third identifying as immigrants, more than half identifying a primary language other than English, and over 80% identifying as Black or Hispanic. This adds to the complexity of providing comprehensive pediatric hospice services as teams need to include clinicians that can provide culturally competent care. To serve this population, our team now provides hospice services via our institution’s telehealth platform.

Design/Methods: Our program has tried to improve access to pediatric hospice support and provide culturally competent care through an interdisciplinary telemedicine model. Our telemedicine program consists of 3 physicians, 1 nurse practitioner, 1 nurse navigator, and one social worker. The physician or nurse practitioner provided symptom management, goals of care conversations, anticipatory grief support, and advanced care planning. The nurse navigator provided care coordination with other primary specialists, case management needs for equipment, and prior authorization for medications. The social worker follows up as death is imminent or after death to aid in funeral arrangements or provide bereavement resources.

Results: Thus far we have provided hospice services to 12 patients. Of the 12 patients, 1 died at home with no home hospice services besides our service, Two were admitted to adult-only hospice for end-of-life care and 10 died in a hospital within 72 hours after being admitted. Ten patients received our pediatric hospice telehealth services along with concurrent disease-directed therapies. Primary diagnoses were either genetic or oncological conditions.

Conclusion/Discussion: While efforts have been made to expand access to pediatric hospice services, such as the “Concurrent care for Children” mandate, receiving this benefit is limited for a variety of reasons. Challenges noted in our patient population included Medicaid eligibility due to immigration status, lack of pediatric hospice programs, and various cultural perspectives on hospice care. Gaps in pediatric hospice services can be improved through utilization of pediatric hospice telehealth programs delivered by an interdisciplinary pediatric palliative care team. While pediatric telehealth has become more commonly utilized, the benefit of telehealth for pediatric hospice has not fully been explored given the challenges to access. Furthermore, interdisciplinary pediatric hospice telehealth teams that can provide culturally competent care can be a valuable tool for providing comprehensive pediatric hospice services.