Objectives
We sought to characterize the number and types of care transitions in the last 6 months of life made by patients who used hospice and examined factors associated with having multiple transitions in care.
Design, Setting, and Participants
We performed a retrospective cohort study of fee-for-service Medicare beneficiaries, aged 66 years or older who died between July 1, 2011 and December 31, 2011, and were enrolled in hospice at some time during the last 6 months of life. We used hierarchical generalized linear modeling to identify patient, hospice, and regional factors associated with transitions. We also described the sequence of transitions across healthcare settings.
Measures
Healthcare transitions after hospice enrollment included from/to hospital, skilled nursing facility, home health agency program, hospice, or home without receiving any service above.
Results
Among 311,090 hospice decedents, 31,675 (10.2%) had at least one transition after hospice enrollment and this varied substantially across the United States. A total of 6.6% of all decedents had more than one transition in care after hospice enrollment, with a range from 2–19 transitions. Among hospice users with transitions, 53.4% were admitted to hospitals, 17.7% were admitted to skilled nursing facilities, 9.6% used home health agencies, and 25.8% had transitions to home without receiving services we examined. In adjusted analyses, decedents who were younger, nonwhite, enrolled in a for-profit or small hospice program, or had less access to hospital-based palliative care had significantly higher odds of having at least one transition.
Conclusion
A notable proportion of hospice users experience at least one transition in care in the last 6 months of life, suggesting further research on their impact on patients and families is warranted.