Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. e932-e939 (doi:10.1542/peds.2005-2078)
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Distance From Home When Death Occurs: A Population-Based Study of Washington State, 1989–2002

Chris Feudtner, MD, PhD, MPHa, Maria J. Silveira, MD, MPHb, Mayadah Shabbout, MSc and Richard E. Hoskins, PhDd

a Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
b Health Services Research and Development Center of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan
c Division of Biostatistics and Epidemiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
d Washington State Department of Health, Olympia, Washington

OBJECTIVE. For patients who die in hospitals, the regionalization of tertiary health care services may be increasing the home-to-hospital distance, particularly for younger patients whose care is especially regionalized and for whom access to and use of home hospice services remains limited. The objective of this study was to test the hypotheses that the distance from home at the time of death in a hospital has increased over time and is inversely related to the age of the dying patient.

METHODS. A population-based case series was conducted in Washington State of all deaths of state residents from 1989 to 2002. The main outcome measure was driving distance between home residence and location at the time of death.

RESULTS. The overall mean distance from home to the hospital where death occurred has increased by 1% annually. Children who died in hospitals were much farther from home than their adult counterparts: the mean distance was 37.4 km for neonates and 50.9 km for children who were aged 1 to 9 years, compared with 19.9 km for adults who were aged 60 to 79 years and 14.0 km for patients who were older than 79 years. Disparities of distance were even greater among patients who were at the 90th percentile for distance (85.6 km for neonates compared with 30.8 for patient who were older than 79 years).

CONCLUSIONS. The distance between home residence and the hospital where death occurs is greatest for children and has increased over time. Both of these findings have implications for the design of local and regional pediatric end-of-life supportive care services.

Key Words: end of life • palliative care • hospitalization • hospice care • geography

Accepted Oct 24, 2005.


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