Variation in receipt of opioids by pediatric oncology patients who died in children's hospitals

Andrea D. Orsey, Jean B. Belasco, Jonas H. Ellenberg, Kathryn H. Schmitz, Chris Feudtner

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)761-766
Number of pages6
JournalPediatric Blood and Cancer
Volume52
Issue number7
DOIs
StatePublished - Jul 1 2009

Fingerprint

Opioid Analgesics
Pediatrics
Prescriptions
Health Information Systems
Pain

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Orsey, Andrea D. ; Belasco, Jean B. ; Ellenberg, Jonas H. ; Schmitz, Kathryn H. ; Feudtner, Chris. / Variation in receipt of opioids by pediatric oncology patients who died in children's hospitals. In: Pediatric Blood and Cancer. 2009 ; Vol. 52, No. 7. pp. 761-766.
@article{d49ebd9a7b284980b30c5d9e909e5115,
title = "Variation in receipt of opioids by pediatric oncology patients who died in children's hospitals",
abstract = "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.",
author = "Orsey, {Andrea D.} and Belasco, {Jean B.} and Ellenberg, {Jonas H.} and Schmitz, {Kathryn H.} and Chris Feudtner",
year = "2009",
month = "7",
day = "1",
doi = "10.1002/pbc.21824",
language = "English (US)",
volume = "52",
pages = "761--766",
journal = "Pediatric Blood and Cancer",
issn = "1545-5009",
publisher = "Wiley-Liss Inc.",
number = "7",

}

Variation in receipt of opioids by pediatric oncology patients who died in children's hospitals. / Orsey, Andrea D.; Belasco, Jean B.; Ellenberg, Jonas H.; Schmitz, Kathryn H.; Feudtner, Chris.

In: Pediatric Blood and Cancer, Vol. 52, No. 7, 01.07.2009, p. 761-766.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Variation in receipt of opioids by pediatric oncology patients who died in children's hospitals

AU - Orsey, Andrea D.

AU - Belasco, Jean B.

AU - Ellenberg, Jonas H.

AU - Schmitz, Kathryn H.

AU - Feudtner, Chris

PY - 2009/7/1

Y1 - 2009/7/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=67650493566&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67650493566&partnerID=8YFLogxK

U2 - 10.1002/pbc.21824

DO - 10.1002/pbc.21824

M3 - Article

C2 - 18989880

AN - SCOPUS:67650493566

VL - 52

SP - 761

EP - 766

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

SN - 1545-5009

IS - 7

ER -