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Keywords:

  • health care variation;
  • narcotics;
  • opioids;
  • pain management;
  • palliative care;
  • pediatric oncology

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. Pediatr Blood Cancer 2009;52:761–766. © 2008 Wiley-Liss, Inc.