Application of Instrumental Variable Analysis in Pediatric End-of-Life Research: A Case Study

Instrumental variable analysis (IVA) has been widely used in many fields, including health care, to determine the comparative effectiveness of a treatment, intervention, or policy. However, its application in pediatric end-of-life care research has been limited. This article provides a brief overvie...

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Bibliographic Details
Published in:Western journal of nursing research 2023-06, Vol.45 (6), p.571-580
Main Authors: Svynarenko, Radion, Cozad, Melanie J., Mack, Jennifer W., Keim-Malpass, Jessica, Hinds, Pamela S., Lindley, Lisa C.
Format: Article
Language:English
Subjects:
Child
Death
End of life decisions
Health care
Hospice Care
Humans
Medicaid
Medical research
Medical treatment
Palliative Care
Patient Protection and Affordable Care Act
Pediatrics
Quasi-experimental methods
Research methodology
Terminal Care
Terminal illnesses
United States
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Summary:Instrumental variable analysis (IVA) has been widely used in many fields, including health care, to determine the comparative effectiveness of a treatment, intervention, or policy. However, its application in pediatric end-of-life care research has been limited. This article provides a brief overview of IVA and its assumptions. It illustrates the use of IVA by investigating the comparative effectiveness of concurrent versus standard hospice care for reducing 1-day hospice enrollments. Concurrent hospice care is a relatively recent type of care enabled by the Affordable Care Act in 2010 for children enrolled in the Medicaid program and allows for receiving life-prolonging medical treatment concurrently with hospice care. The IVA was conducted using observational data from 18,152 pediatric patients enrolled in hospice between 2011 and 2013. The results indicated that enrollment in concurrent hospice care reduced 1-day enrollment by 19.3%.
ISSN:0193-9459
1552-8456
DOI:10.1177/01939459231163441