A National Study of Live Discharges from Hospice

AbstrAct:The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidencebased care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient-and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient's family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payerprovider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.

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“…115 Although patients have higher rates of live discharge from hospice, services remain underused in this population. 116 …”

Section: Patient Outcomesmentioning

confidence: 99%

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Braun¹,

Grady²,

Kutner³

et al. 2016

Circulation

199

143

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“…3,4 Although hospice interdisciplinary teams and informal caregivers work in tandem to address the needs of patients on home hospice, approximately one out of every five patients disenrolls and up to 25% of those disenrolled patients return to the hospital within 30 days of discharge. 5 These care transitions can be detrimental to patients, given the disruption in continuity of care and possibly receiving unwanted care provided by different hospital providers who may be unaware of patients' care preferences. 6,7 Furthermore, many patients prefer to die at home and especially for those patients who elect hospice care, a hospitalization is a potentially burdensome and costly care transition.…”

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confidence: 99%

Events Leading to Hospital-Related Disenrollment of Home Hospice Patients: A Study of Primary Caregivers' Perspectives

Phongtankuel

Paustian

Reid

et al. 2017

Journal of Palliative Medicine

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Background: Approximately 25% of hospice disenrollments in the United States occur as the result of hospitalization, which can lead to burdensome transitions and undesired care. Informal caregivers (e.g., spouses, children) play a critical role in caring for patients on home hospice. Research examining hospital-related disenrollment among these patients is limited. Objective: To understand the events surrounding the hospitalization of patients discharged from home hospice through the perspective of their informal caregivers. Design: Thirty-eight semistructured phone interviews with caregivers were conducted, and data regarding the events leading to hospitalization and hospice disenrollment were collected. Study data were analyzed by using qualitative methods. Setting/Subjects: Subjects included caregivers of 38 patients who received services from one not-for-profit home hospice organization in New York City. Participants were English speaking only. Measurements: Caregiver recordings were transcribed and analyzed by using content analysis. Results: Content analysis revealed four major themes contributing to hospitalization: (1) distressing/difficult-towitness signs and symptoms, (2) needing palliative interventions not deliverable in the home setting, (3) preference to be cared for by nonhospice physicians or at a local hospital, and (4) caregivers not comfortable with the death of their care recipient at home. Over half of all caregivers called 911 before calling hospice. Conclusions: Our study provides insight into the events leading to hospitalization of home hospice patients from the caregivers' perspective. Further research is needed to quantify the drivers of hospitalization and to develop interventions that reduce utilization, while improving care for home hospice patients and their caregivers.

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“…6 Similarly, a report on Medicare Hospice Payment Reform in 2014 revealed that 6.7% of all hospice admissions result in an emergency room (ER) visit, observational stay (OS), or inpatient visit (IV), which amounts to over 100,000 affected patients annually. 7 Hospitalization can be detrimental to home hospice patients and their family members.…”

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confidence: 99%

“…Given that the majority of hospice patients who become hospitalized reenroll back into the program, these care transitions can be burdensome for patients and families and lead to poor patient outcomes. 6,11 Studies examining reasons for hospitalizations among hospice or palliative care patients are few. One study examined caregivers' reasons for transferring home hospice patients to an inpatient facility, defined as an inpatient hospice unit, acute care hospital, or nursing home.…”

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confidence: 99%

Why Do Home Hospice Patients Return to the Hospital? A Study of Hospice Provider Perspectives

PhongtankuelVeerawat

ScherbanBenjamin

ReidManney

et al. 2016

Journal of Palliative Medicine

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Background: Hospice provides an opportunity for patients to receive care at home at the end of life (EOL); however, approximately 25% of patients who disenroll from hospice are hospitalized. Hospitalization can lead to poor care transitions and result in unwarranted care and adverse patient outcomes. Research examining reasons for hospitalization in this patient population is limited. Objective: The objective was to understand the reasons for hospitalization among home hospice patients through the perspectives of hospice interdisciplinary team (IDT) members. Methods: This was a qualitative study using a grounded theory approach. Seven semistructured focus group were conducted to solicit reasons for hospitalization among home hospice patients. Participants consisted of 73 home hospice IDT members from a not-for-profit hospice agency in New York City. Focus group recordings were transcribed and analyzed using content analysis. Results: Eight major themes were identified: (1) not fully understanding hospice, (2) lack of clarity about disease prognosis, (3) desire to continue receiving care from nonhospice physicians and hospital, (4) caregiver burden, (5) distressing/difficult-to-manage signs and symptoms, (6) caregivers' reluctance to administer morphine, (7) 911's faster response time compared to hospice, and (8) families' difficulty accepting patients' mortality. Conclusions: Reasons for hospitalization in home hospice patients are multifactorial and complex. Our study highlights barriers and challenges that patients, families, physicians, and hospices face around home hospice care and hospitalization. More research is needed to elucidate these issues and develop viable strategies to address them.

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A National Study of Live Discharges from Hospice

Abstract: Approximately 1 in 5 hospice patients are discharged alive with variation by geographic regions and hospice programs. Not-for-profit hospices and older hospices have lower rates of live discharge.

Cited by 84 publications

References 13 publications

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

Events Leading to Hospital-Related Disenrollment of Home Hospice Patients: A Study of Primary Caregivers' Perspectives

Why Do Home Hospice Patients Return to the Hospital? A Study of Hospice Provider Perspectives

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