Document Detail

Variation in receipt of opioids by pediatric oncology patients who died in children's hospitals.
MedLine Citation:
PMID:  18989880     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Opioids are a cornerstone of palliation of pain. We sought to assess variation in opioid prescription during the last week of life among a cohort of pediatric oncology patients who died while hospitalized. PROCEDURE: We used detailed hospital administrative data from the Pediatric Health Information System (PHIS) regarding 1,466 subjects 0-24 years of age who were treated at 33 hospitals between 2001 and 2005. RESULTS: Among the 1,466 subjects hospitalized at the time of their death, 56% received opioids every day during the hospitalized portion of their last week of life, while 44% did not. This proportion varied substantially across hospitals (range 0-90.5%). After multivariate adjustment for individual-level characteristics, the hospital-level effect on the odds of continuous prescription of opioids during the hospitalized portion of the last 7 days of life continued to vary significantly among hospitals, accounting for 10.5% of the variance in the receipt of daily opioid (P < 0.001). CONCLUSION: Opioid prescription during the hospitalized portion of the last week of life varies substantially among hospitals, even after adjustment for clinical characteristics of the patients. The reasons for this significant variation, especially the component explained by hospital-level and not patient-level factors, warrant more scrutiny.
Andrea D Orsey; Jean B Belasco; Jonas H Ellenberg; Kathryn H Schmitz; Chris Feudtner
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Pediatric blood & cancer     Volume:  52     ISSN:  1545-5017     ISO Abbreviation:  Pediatr Blood Cancer     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-04-13     Completed Date:  2009-05-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101186624     Medline TA:  Pediatr Blood Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  761-6     Citation Subset:  IM    
Copyright Information:
(c) 2008 Wiley-Liss, Inc.
Division of Hematology/Oncology, Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA.
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MeSH Terms
Analgesics, Opioid / therapeutic use*
Attitude of Health Personnel
Child, Preschool
Cohort Studies
Drug Utilization / statistics & numerical data
Hospital Mortality*
Hospitals, Pediatric
Length of Stay
Neoplasms / drug therapy*,  mortality
Pain / drug therapy*
Physician's Practice Patterns / statistics & numerical data*
Survival Rate
Terminal Care / statistics & numerical data*
Treatment Outcome
Young Adult
Grant Support
5-T32-CA-009679/CA/NCI NIH HHS
Reg. No./Substance:
0/Analgesics, Opioid
Comment In:
Pediatr Blood Cancer. 2009 Jul;52(7):749-50   [PMID:  19061236 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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