| This study identified factors related to pediatric palliative care (PPC) referral, located the barriers to early integration, and proposed strategies for enhancing early access. Administrative data was extracted from the palliative care team's administrative records and the electronic health records system at an urban Children's Hospital. Also, an anonymous and voluntary electronic survey about care providers' perspectives on PPC was administered to the staff. Statistical analyses showed that diagnostic category proved to be useful as a predictor for probability of PPC referral, and could be used as a primary criterion to trigger prospective referral. Diagnosis in conjunction with other variables that indicate medical complexity, acuity, or severity of illness will be more accurate in identifying children who would benefit from PPC. Logistical and perceptual barriers were articulated by staff in survey responses (n=171), and confirmed that despite having knowledge of PPC principles, staff members reported-referral-behaviors did not reflect these principles in practice. Negative connotations of PPC delay timely referrals, however staff members are receptive to additional education/training and tools that would help identify PPC-eligible children sooner and make referrals earlier in the illness trajectory. Health information technology such as clinical decision support systems within electronic health records can potentially aid in efficiently identifying and referring eligible patients to PPC early in their illness trajectory. |
