A National Study of Live Hospice Discharges between 2000 and 2012

Prsic, Elizabeth Horn; Plotzke, Mike; Christian, Thomas; Gozalo, Pedro; Teno, Joan M.

doi:10.1089/jpm.2015.0383

Cited by 26 publications

(16 citation statements)

References 13 publications

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“…Making advance determinations about which patients with advanced pulmonary or heart disease are likely to die within 6 months is often unrealistic due to unpredictable terminal trajectories . This may also be true for patients with debility or adult failure to thrive, conditions that represented an increasing number of hospice admissions over the past decade, but which were no longer allowable as primary diagnoses under 2014 Medicare guidelines . Likely because of this new rule, a limited number of patients in our analytic sample had this primary diagnosis (n = 180).…”

Section: Discussionmentioning

confidence: 99%

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Frequency and Risk Factors for Live Discharge from Hospice

Russell

Diamond

Lauder

et al. 2017

J American Geriatrics Society

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Section: Discussionmentioning

confidence: 99%

“…While hospice use has increased, nearly one of every five patients is discharged before death (i.e., “live discharge”) . The live discharge rate increased over the past decade—from 13.7% in 2000 to 18.1% in 2012 . Live discharge may presage burdensome transitions and aggressive end of life care .…”

mentioning

confidence: 99%

Frequency and Risk Factors for Live Discharge from Hospice

Russell

Diamond

Lauder

et al. 2017

J American Geriatrics Society

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“…38 Third, a negative binomial model was used to explore the relationship between usual source of care and hospice length of stay. 33 The negative binomial results were reported as adjusted incidence rate ratios (IRR). All analyses were conducted using Stata 11.0 (StataCorp LP, College Station, TX).…”

Section: Methodsmentioning

confidence: 99%

End-of-Life Transitions and Hospice Utilization for Adolescents

Keim‐Malpass

Lindley

2017

J Hosp Palliat Nurs

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Adolescents with life-limiting illnesses have intensive end-of-life trajectories and could benefit from initiation of hospice services. The medical home model, which includes having a usual source of primary care, may help facilitate quality outcomes at the end-of-life for adolescents. The purpose of this study was to determine the relationship between having a usual source of primary care on hospice utilization and end-of-life transitions among adolescents between 15–20 years with a life-limiting illness. A retrospective cohort design used 2007–2010 California Medicaid claims data (n=585). Our dependent variables were hospice utilization (i.e., hospice enrollment, hospice length of stay) and the independent variable was usual source of primary care. Multivariate regression techniques including least squares regression, multivariate logistic regression, and negative binomial regression were used in the analysis of the relationship between usual source of primary care and hospice utilization and end-of-life transitions. Ten percent of our sample utilized hospice services. Having a usual source of primary care was associated with an increase in hospice enrollment, hospice length of stay, and end-of-life transitions. Adolescents with a cancer diagnosis were more likely to enroll in hospice services. For adolescents at the end of life, having a usual source of primary care had a significant impact on hospice enrollment and length of stay. This study is among the first to demonstrate a relationship between primary care and hospice use among this vulnerable population.

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“…Roughly 20% of hospice patients experience live discharge from hospice before death . Live discharge is frequently a burdensome and disruptive transition for patients and their family members, who may lose services and support they have come to depend on such as nursing, social work, home health aides, and spiritual care .…”

mentioning

confidence: 99%

“…R oughly 20% of hospice patients experience live discharge from hospice before death. [1][2][3][4][5] Live discharge is frequently a burdensome and disruptive transition for patients and their family members, who may lose services and support they have come to depend on such as nursing, social work, home health aides, and spiritual care. [6][7][8] Live discharge occurs for several reasons including patient/family preferences and distressing symptoms that lead to calling emergency services.…”

mentioning

confidence: 99%

Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia

Luth

Russell

Brody

et al. 2019

J American Geriatrics Society

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OBJECTIVES The end‐of‐life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia. DESIGN Retrospective cohort study. SETTING A large not‐for‐profit agency in New York City. PARTICIPANTS A total of 2629 hospice patients with dementia age 65 years and older. MEASUREMENTS Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits). RESULTS Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI] = 1.34‐4.38; Hispanic: aOR = 2.99; 95% CI = 1.81‐4.94). Home hospice (aOR = 7.57; 95% CI = 4.04‐14.18), longer length of service (aOR = 1.04; 95% CI = 1.04‐1.05), and more days between nurse visits and discharge (aOR = 1.86; 95% CI = 1.56‐2.21) were also associated with live discharge. CONCLUSION To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end‐of‐life trajectory of patients with dementia. J Am Geriatr Soc 68:551–558, 2020

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A National Study of Live Hospice Discharges between 2000 and 2012

Abstract: Live hospice discharges and burdensome transitions increased between 2000 and 2012. For-profit hospice programs demonstrated larger increases than nonprofit hospice programs.

Cited by 26 publications

References 13 publications

Frequency and Risk Factors for Live Discharge from Hospice

Frequency and Risk Factors for Live Discharge from Hospice

End-of-Life Transitions and Hospice Utilization for Adolescents

Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia

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