National Hospice Survey Results

Aldridge, Melissa D.; Schlesinger, Mark; Barry, Colleen L.; Morrison, R. Sean; McCorkle, Ruth; Hurzeler, Rosemary; Bradley, Elizabeth H.

doi:10.1001/jamainternmed.2014.3

Cited by 66 publications

(33 citation statements)

References 22 publications

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“…Lower use of hospice services among patients with traditional Medicare insurance, as compared with those with commercial insurance was previously described in the general population [26, 27], as was noted consistently in the present cohort, though the underlying explanations remain elusive [26]. Although charity care is offered by many hospice providers [2], this is not the case for about one in five non-profit or for-profit facilities [28], which may have contributed to the lower odds of hospice use in the present cohort among those lacking health insurance. However, lack of health insurance was no longer significant predictor of hospice use by the end of the last decade, possibly reflecting improved access for these patients.…”

Section: Discussionsupporting

confidence: 61%

Predictors of Transition to Hospice Care Among Hospitalized Older Adults With a Diagnosis of Dementia in Texas: A Population-Based Study

Oud

2017

J Clin Med Res

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BackgroundDecedent older adults with dementia are increasingly less likely to die in a hospital, though escalation of care to a hospital setting, often including critical care, remains common. Although hospice is increasingly reported as the site of death in these patients, the factors associated with transition to hospice care during end-of-life (EOL) hospitalizations of older adults with dementia and the extent of preceding escalation of care to an intensive care unit (ICU) setting among those discharged to hospice have not been examined.MethodsWe identified hospitalizations aged ≥ 65 years with a diagnosis of dementia in Texas between 2001 and 2010. Potential factors associated with discharge to hospice were evaluated using multivariate logistic regression modeling, and occurrence of hospice discharge preceded by ICU admission was examined.ResultsThere were 889,008 elderly hospitalizations with a diagnosis of dementia during study period, with 40,669 (4.6%) discharged to hospice. Discharges to hospice increased from 908 (1.5%) to 7,398 (6.3%) between 2001 and 2010 and involved prior admission to ICU in 45.2% by 2010. Non-dementia comorbidities were generally associated with increased odds of hospice discharge, as were development of organ failure, the number of failing organs, or use of mechanical ventilation. However, discharge to hospice was less likely among non-white minorities (lowest among blacks: adjusted odds ratio (aOR): 0.67; 95% confidence interval (CI): 0.65 - 0.70) and those with non-commercial primary insurance or the uninsured (lowest among those with Medicaid: aOR (95% CI): 0.41 (0.37 - 0.46)).ConclusionsThis study identified potentially modifiable factors associated with disparities in transition to hospice care during EOL hospitalizations of older adults with dementia, which persisted across comorbidity and severity of illness measures. The prevalent discharge to hospice involving prior critical care suggests that key discussions about goals-of-care likely took place following further escalation of care to ICU. Together these findings can inform system- and clinician-level interventions to facilitate timely and consistent use of hospice to meet patients’ goals of care.

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Section: Discussionsupporting

confidence: 61%

Predictors of Transition to Hospice Care Among Hospitalized Older Adults With a Diagnosis of Dementia in Texas: A Population-Based Study

Oud

2017

J Clin Med Res

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“…(8–11) A recent survey-based study reported that for-profit agencies provide less charity care and fewer training opportunities than not-for-profits, while also engaging in greater outreach to minority and low-income communities. (12)…”

Section: Introductionmentioning

confidence: 99%

“…Analyses based on a national survey of hospice agencies included chain status as a control variable in examining for-profit vs. not-for-profit differences in enrollment practices and the provision of community benefits; (4, 15) another article using the same dataset examined the influence of chain status on self-reported care practices, finding that chain agencies (the article did not distinguish between for-profit and not-for-profit chains) generally offered higher quality of care relative to non-chains. (12) To date, the literature has not comprehensively studied the patients and actual service provision of the diverse for-profit and not-for-profit chains that now serve around half of all United States hospice enrollees. (16)…”

Section: Introductionmentioning

confidence: 99%

Effect of Ownership on Hospice Service Use: 2005–2011

Stevenson

Grabowski

Keating

et al. 2016

J American Geriatrics Society

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Background/Objectives For-profit agencies comprise the majority of all United States hospice agencies, prompting concerns about aggressive enrollment practices and deficient care. Using detailed administrative data from 2005–2011, we sought to assess differences in patient populations and service use by hospice ownership, chain status, and agency size. Design/Participants Retrospective cohort study of 5,405,526 Medicare beneficiaries age 65+ enrolled in hospice during 2005–2011. Hospice use by ownership category (for-profit non-chain and chain, not-for-profit non-chain and chain, government) and agency size (0–50 patients, 51–200, 201–400, 401+). Mean length-of-use, stays ≤3 days, stays ending with live discharge, and decedents receiving no general inpatient care (GIP) or continuous home care (CHC) level hospice in the last 7 days of life. Results After adjusting for patient and geographic differences, for-profit non-chain and chain agencies had longer mean lengths-of-use (84.5 and 91.2 days, respectively) than other agency types (66.3–72.5 days); higher rates of live discharge (21.0% and 20.2% versus 14.6%–15.9%); and lower proportions of stays of ≤3 days (13.9% and 14.7% versus 16.6%–17.5%) (all p-values<0.001). The proportion of decedents not receiving GIP/CHC level care before death was highest among for-profit chains (75.9%) and lowest among not-for-profit non-chains (63.2%). Across ownership categories, smaller agencies had longer mean lengths-of-use, higher live discharge rates, lower rates of stays ≤3 days, and higher rates of patients receiving no GIP/CHC level care. Considerable variation in patient traits and unadjusted service use existed among the nation’s largest chains. Conclusion Although for-profit and not-for-profit hospice agencies differ along key dimensions, our results convey substantial heterogeneity within these categories, highlighting the need to consider factors such as agency size and chain affiliation in understanding variations in Medicare beneficiaries’ hospice care.

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“…Length of hospice stay from hospice enrollment to death or disenrollment was included in all models as a potential confounder of the association between hospice characteristics and disenrollment, based on our prior work. 3,4,16 Consistent with prior work, we identified individuals as having disenrolled from hospice if: (1) they had only 1 hospice enrollment period and the patient status indicator code on the final hospice claim indicated that the patient was discharged (rather than died) and there was no date of death on the final hospice claim; or (2) if they had >1 hospice enrollment period. We categorized patterns of hospice disenrollment as (1) disenrollment in conjunction with an acute hospitalization or ED visit, (2) disenrollment following long hospice stays (defined as more than 165 days), and (3) disenrollment following hospice stays shorter than 165 days.…”

Section: Methodsmentioning

confidence: 85%

“…3 As codified under Medicare, hospice provides a package of clinical and psychosocial services to Medicare beneficiaries who are considered to have a terminal diagnosis (defined as a life expectancy of ≤6 months) and who are willing to forgo Medicare coverage for curative treatment. 4 In the late 1990s, only 3.3% of those who used hospice had a primary diagnosis of dementia. 5 By 2014, an estimated 14.8% of hospice users had a primary diagnosis of dementia.…”

mentioning

confidence: 99%

Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study

Vleminck

Morrison

Meier

et al. 2018

Journal of the American Medical Directors Association

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Background Patients with dementia form an increasing proportion of those entering hospice care. Little is known about the types of hospices serving patients with dementia and the patterns of hospice use, including timing of hospice disenrollment between patients with and without dementia. Objectives To characterize the hospices that serve patients with dementia, to compare patterns of hospice disenrollment for patients with dementia and without dementia, and to evaluate patient-level and hospice-level characteristics associated with hospice disenrollment. Methods We used data from a longitudinal cohort study (2008–2011) of Medicare beneficiaries (n = 149,814) newly enrolled in a national random sample of hospices (n = 577) from the National Hospice Survey and followed until death (84% response rate). Results A total of 7328 patients (4.9%) had a primary diagnosis of dementia. Hospices caring for patients with dementia were more likely to be for-profit, larger sized, provide care for more than 5 years, and serve a large (>30%) percentage of nursing home patients. Patients with dementia were less likely to disenroll from hospice in conjunction with an acute hospitalization or emergency department visit and more likely to disenroll from hospice after long enrollment periods (more than 165 days) as compared with patients without dementia. No significant difference was found between patients with and without dementia for disenrollment after shorter enrollment periods (less than 165 days). In the multivariable analyses, patients were more likely to be disenrolled after 165 days if they were served by smaller hospices and hospices that served a small percentage of nursing home patients. Conclusion Patients with dementia are significantly more likely to be disenrolled from hospice following a long enrollment period compared with patients without dementia. As the number of individuals with dementia choosing hospice care continues to grow, it is critical to address potential barriers to the provision of quality palliative care for this population near the end of life.

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National Hospice Survey Results

Cited by 66 publications

References 22 publications

Predictors of Transition to Hospice Care Among Hospitalized Older Adults With a Diagnosis of Dementia in Texas: A Population-Based Study

Predictors of Transition to Hospice Care Among Hospitalized Older Adults With a Diagnosis of Dementia in Texas: A Population-Based Study

Effect of Ownership on Hospice Service Use: 2005–2011

Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study

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