Rehospitalization of Older Adults Discharged to Home Hospice Care

Abstract

Background: Acute hospital readmission of older adults receiving hospice care is not aligned with hospice goals. Objective: To identify factors associated with 30-day readmission among older adults newly discharged to hospice. Design/Subjects: Medical record review of 59 patients, 19 readmitted within 30 days and 40 randomly selected controls not readmitted, from 206 patients newly discharged to home hospice care between February 1, 2005 and January 31, 2010. Measures/Analysis: Information was collected about hospital course, end-of-life planning, and posthospitalization follow-up. We calculated bivariate associations and developed a Cox Proportional Hazards model examining the relation between index admission characteristics and readmission. Results: Patients' mean age was 79.7 -8.4; 74.6% were female; 52.5% were black. Among those readmitted, 25% had received a palliative care consultation, compared to 47.1% of those not readmitted ( p = 0.06). Patients without a participating decision-maker involved in their hospice decision had 3.5 times the risk of readmission within 30 days, compared to those with (hazard ratio [HR] 3.53, confidence interval [CI] 0.97, 12.82). Patients who had one or more telephone contacts with their primary care physician (PCP) during week 1 after discharge had 2.4 times the readmission risk within 30 days, compared to patients with no such contacts during this period (HR 2.35, CI 0.9, 6.1). Conclusions: Readmission within 30 days of initial discharge to hospice is associated with several measures of care and care planning. Further study of these measures may identify opportunities for interventions to improve the hospital-to-hospice transition and to decrease hospital readmissions.

The transition of palliative care from the hospital to the home: a narrative review of experiences of patients and family caretakers

“…41,43,44 From this review, we may also derive the need to continue implementing and evaluating cares that are being valued as very positive by patients and family caretakers for a positive transition between the hospital and the home. Among others, they highlight the following: education of the dyad during hospital discharge, 35,38,45 telephone follow up, 46,47 homecare teams, 48,49 and support groups of patients and caregivers. 30,31 Regarding these types of support, Stajduhar et al, 50 comment that the nature of the experiences of the dyads in PC can vary according to the structure of the health systems and of the social services, of access to services, and of the types of support available.…”

Effect of Primary Care Involvement on End‐of‐Life Care Outcomes: A Systematic Review

“…The relationship between PCP involvement and ED or hospital admission was mixed. Although two studies found that PCP involvement was associated with lower odds of ED or hospital admission, two studies reported the opposite, and another two found no association . A Canadian study of 8,702 individuals with cancer concluded that greater family physician continuity was associated with lower ED admission rates .…”

“…PCP involvement was not uniformly measured across all studies (Table ). Some studies examined the number of PCP outpatient, home, or telephone contacts during a specified time frame. Others assessed whether a PCP was involved in participants' care in different settings (e.g., home, hospice, hospital) .…”

“…The two studies demonstrating more ED visits and hospitalizations used measures of PCP involvement that would be assumed to increase healthcare use. The largest of these studies examined PCP involvement within the year before a cancer diagnosis, and the other study assessed whether a PCP provided a telephone consultation within 1 week of hospital discharge . Measures of PCP involvement that better reflect care at the end of life should be studied to better understand the influence of PCP care on ED visits and hospitalizations.…”

Inpatient End-of-Life Decisions Informed by Definitive Diagnosis

“…1 Acute hospital readmission for patients in hospice is an active area of research. 2 In addition to caring for already dying patients, hospitalists also diagnose and manage new imminently life-threatening conditions and their devastating complications.…”