A Policy Prescription for Hospice Care

Odejide, Oreofe O.

doi:10.1001/jama.2015.18424

Cited by 35 publications

(20 citation statements)

References 5 publications

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“…13 Therefore, elucidating the role of TD in the use of hospice services could have important policy implications and may be critical in the quest to improve the quality of EOL care in leukemia. [14][15][16] Our objective was to examine the association between TD and the use of hospice services or duration of hospice length of stay in a population-based sample of older patients with acute and chronic leukemias. We hypothesized that TD would be associated with less frequent use of hospice and shorter hospice stays and that the association would be similar for acute and chronic leukemias, despite their clinical dissimilarity.…”

Section: Introductionmentioning

confidence: 99%

Transfusion dependence, use of hospice services, and quality of end-of-life care in leukemia

LeBlanc

Egan

Olszewski

2018

Blood

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Hospice provides high-quality end-of-life care, but patients with leukemias use hospice services less frequently than those with solid tumors. Transfusion dependence (TD) may hinder or delay enrollment, because hospice organizations typically disallow transfusions. We examined the association between TD and end-of-life outcomes among Medicare beneficiaries with leukemia. From the Surveillance, Epidemiology, and End Results-Medicare database, we selected beneficiaries with acute and chronic leukemias who died in 2001-2011. We defined TD as ≥2 transfusions within 30 days before death or hospice enrollment. End points included hospice enrollment and length of stay, reporting relative risk (RR) adjusted for key covariates. Among 21 033 patients with a median age of 79 years, 20% were transfusion dependent before death/hospice enrollment. Use of hospice increased from 35% in 2001 to 49% in 2011. Median time on hospice was 9 days and was shorter for transfusion-dependent patients (6 vs 11 days; < .001). Adjusting for baseline characteristics, TD was associated with a higher use of hospice services (RR, 1.08; 95% confidence interval [CI], 1.04-1.12) but also with 51% shorter hospice length of stay (RR, 0.49; 95% CI, 0.44-0.54). Hospice enrollees had a lower likelihood of inpatient death and chemotherapy use and lower median Medicare spending at end-of-life, regardless of TD status. In conclusion, relatively increased hospice use combined with a markedly shorter length of stay among transfusion-dependent patients suggests that they have a high and incompletely met need for hospice services and that they experience a barrier to timely referral. Policy solutions supporting palliative transfusions may maximize the benefits of hospice for leukemia patients.

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Section: Introductionmentioning

confidence: 99%

Transfusion dependence, use of hospice services, and quality of end-of-life care in leukemia

LeBlanc

Egan

Olszewski

2018

Blood

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“…Crude rules such as this take no account of different illness trajectories and so may discriminate against those with severe, on-going illness [ 51 ], create ethical issues for the clinicians involved as gatekeepers [ 52 ], rely on potentially inaccurate estimates of life expectancy [ 53 , 54 ] and undermine a more holistic vision for the role of palliative care [ 55 ]. They are especially cruel if accompanied by limitations on the extent to which patients receiving palliative care can also receive intensive disease–directed treatments such as blood transfusions, which may be aimed at improving quality of life [ 56 ]. Rules put in place in the United States may have been developed because of the absence of universal coverage for substitute services such as residential (nursing home) care.…”

Section: Introductionmentioning

confidence: 99%

Aligning policy objectives and payment design in palliative care

Duckett¹

2018

BMC Palliat Care

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BackgroundPayment models for palliative care vary across nations, with few adopting contemporary payments designs that apply to other parts of the health system.AimTo propose optimal payment arrangements for palliative care.ApproachReview of relevant literature on funding mechanisms in health care generally and palliative care in particular.ResultsPayment models for palliative care should move toward activity-based funding using an agreed classification, be uncapped funding with performance monitoring, and make explicit use of performance metrics and reporting.ConclusionsIf palliative care is to become a universally accessible service, new approaches to funding, based on the experience of funding reforms in other parts of the health system, need to be adopted.

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“…1 Cancer accounts for the largest category of diagnoses leading to hospice care, representing around 27% of hospice users. 1 Among the 4 most common cancers (breast, prostate, lung, and colorectal), hospice use is highest among patients with lung cancer at around 66.7%. 2 This is likely due to the severity of symptoms and poor prognosis of lung cancer; less than half of patients with lung cancer survive beyond 1 year of diagnosis.…”

mentioning

confidence: 99%

“…A second limitation of prior work was that cost savings were estimated over long time intervals-such as last year of life, 5,6 last 6 months, 4 or last month, 7 while the median length of hospice use was only 17 days, and the average length of stay was around 88.2 days. 8 Given the variation in length of hospice enrollments, useful assessments of hospice savings must: (1) consider the patient's actual length of hospice stay, and (2) use the period during which hospice is actually used for cost comparisons.…”

mentioning

confidence: 99%

Impact of Length of Hospice on Spending and Utilization Among Medicare Beneficiaries With Lung Cancer

Kalidindi

Jung

Segel

et al. 2020

Am J Hosp Palliat Care

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Objectives: To estimate differences in spending and utilization between hospice users and non-users with lung cancer by length of hospice enrollment. Study Design: Retrospective analysis using 2009-2013 Medicare claims. Methods: The study sample was a 10% random sample of Medicare fee-for-service beneficiaries with lung cancer who died between 2010 and 2013. We identified different categories of hospice users (hospice enrollment for 1-7 days, 8-14 days, 15-30 days, 31-60 days, 61 days – 6 months) and non-users. We used propensity score matching to match users in each enrollment category with non-users. The outcomes were: a) total Medicare spending, b) number of hospitalizations, c) number of emergency department (ED) visits, d) number of physician-administered chemotherapy claims, and e) number of radiation therapy sessions. Regression analysis was used to compare outcomes between users and non-users by enrollment period. Results: Hospice users had significantly lower spending, fewer hospitalizations, and fewer ED visits than non-users across all categories of hospice enrollment. Large savings occurred when patients stayed in hospice for at least one month (US$16,566 for those enrolled 61 days – 6 months; US$16,409 for those enrolled 31-60 days). Significant reduction in use of outpatient services including chemotherapy and radiation therapy was observed among patients using hospice for at least 1 month. Conclusions: Hospice led to cost savings by reducing utilization of aggressive care towards end-of-life among lung cancer patients. While cost savings were realized even when hospice is utilized for a short duration, large savings occurred when hospice is used for at least 1 month.

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A Policy Prescription for Hospice Care

Cited by 35 publications

References 5 publications

Transfusion dependence, use of hospice services, and quality of end-of-life care in leukemia

Transfusion dependence, use of hospice services, and quality of end-of-life care in leukemia

Aligning policy objectives and payment design in palliative care

Impact of Length of Hospice on Spending and Utilization Among Medicare Beneficiaries With Lung Cancer

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