Can Hospices Predict which Patients Will Die within Six Months?

Harris, Pamela; Stalam, Tapati; Ache, Kevin A.; Harrold, Joan; Craig, Teresa; Teno, Joan M.; Smither, Eugenia; Dougherty, Meredith; Casarett, David

doi:10.1089/jpm.2013.0631

Cited by 32 publications

(27 citation statements)

References 11 publications

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“…Predictive accuracy for death of the PPSv2 was incrementally improved among patient groups with low PPSv2 scores. 23 Finally, there are mixed perspectives on whether the PPSv2 score should be used as categorical 24,25 (i.e. The findings of this study support the use of the PPSv2 score at admission for estimating survival in the first 30 days of hospice enrolment.…”

Section: Discussionmentioning

confidence: 61%

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Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

et al. 2019

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Aims Estimating survival is challenging in the terminal phase of advanced heart failure. Patients, families, and health‐care organizations would benefit from more reliable prognostic tools. The Palliative Performance Scale Version 2 (PPSv2) is a reliable and validated tool used to measure functional performance; higher scores indicate higher functionality. It has been widely used to estimate survival in patients with cancer but rarely used in patients with heart failure. The aim of this study was to identify prognostic cut‐points of the PPSv2 for predicting survival among patients with heart failure receiving home hospice care. Methods and results This retrospective cohort study included 1114 adult patients with a primary diagnosis of heart failure from a not‐for‐profit hospice agency between January 2013 and May 2017. The primary outcome was survival time. A Cox proportional‐hazards model and sensitivity analyses were used to examine the association between PPSv2 scores and survival time, controlling for demographic and clinical variables. Receiver operating characteristic curves were plotted to quantify the diagnostic performance of PPSv2 scores by survival time. Lower PPSv2 scores on admission to hospice were associated with decreased median (interquartile range, IQR) survival time [PPSv2 10 = 2 IQR: 1–5 days; PPSv2 20 = 3 IQR: 2–8 days] IQR: 55–207. The discrimination of the PPSv2 at baseline for predicting death was highest at 7 days [area under the curve (AUC) = 0.802], followed by an AUC of 0.774 at 14 days, an AUC of 0.736 at 30 days, and an AUC of 0.705 at 90 days. Conclusions The PPSv2 tool can be used by health‐care providers for prognostication of hospice‐enrolled patients with heart failure who are at high risk of near‐term death. It has the greatest utility in patients who have the most functional impairment.

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Section: Discussionmentioning

confidence: 61%

“…This is critical for building an evidence-base that can be applied to patients with similar diagnoses and sociodemographic characteristics. 23 Finally, there are mixed perspectives on whether the PPSv2 score should be used as categorical 24,25 (i.e. groups of PPSv2 scores) or discrete (i.e.…”

Section: Discussionmentioning

confidence: 99%

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

et al. 2019

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“…This live discharge type most often occurs at around 90 and 180 days of service, points at which hospice patients must be recertified as terminally ill. Higher rates of live discharge due to condition stabilization are partially explained by the unclear disease trajectory of PWD and the lack of reliable prognostic tools. Neither the Palliative Performance Scale nor the Reisberg Functional Assessment Staging (FAST) scale, which provide a gauge for hospice of mortality risk, have good predictive values in PWD . Therefore, some PWD far outlive their prognosis; others die sooner.…”

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confidence: 99%

“…This study aims to (1) identify demographic and health correlates of live discharge due to condition stabilization in PWD, and (2) explore how hospice service delivery factors relate to this live discharge type in PWD. We focus on live discharge due to condition stabilization because of its particular importance in PWD, whose odds of experiencing this disenrollment type are more than 13 times greater than for patients with cancer . We use a sample of hospice PWD who did not die within 7 days of enrollment and did not exceed the initial 6‐month period for which the Medicare hospice benefit is intended.…”

mentioning

confidence: 99%

“…Neither the Palliative Performance Scale nor the Reisberg Functional Assessment Staging (FAST) scale, which provide a gauge for hospice of mortality risk, have good predictive values in PWD. 12 Therefore, some PWD far outlive their prognosis; others die sooner. This situation is further complicated by aggressive audits by the Office of the Inspector General toward hospices with high rates of PWD, particularly those in nursing homes.…”

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confidence: 99%

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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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Trends in Hospice Discharge and Relative Outcomes Among Medicare Patients in the Get With The Guidelines–Heart Failure Registry

Warraich

DeVore

et al. 2018

JAMA Cardiol

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Can Hospices Predict which Patients Will Die within Six Months?

Abstract: Hospices might use several variables to identify patients with a relatively low risk for 6-month mortality and who therefore may become ineligible to continue hospice services if they fail to show significant disease progression.

Cited by 32 publications

References 11 publications

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

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

Trends in Hospice Discharge and Relative Outcomes Among Medicare Patients in the Get With The Guidelines–Heart Failure Registry

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