Association of Hospice Patients' Income and Care Level With Place of Death

Barclay, Joshua; Kuchibhatla, Maragatha; Tulsky, James A.; Johnson, Kimberly S.

doi:10.1001/jamainternmed.2013.2773

Cited by 58 publications

(73 citation statements)

References 45 publications

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“…For both disenrollment and hospitalization, we also explored any significant interaction of CHC use with incomes or use of general inpatient hospice care. These two interactions were selected because prior literature had found that CHC effects on dying at home differed by patient’s household incomes, 10 and inpatient hospice care may substitute for CHC use. We included an interaction term between CHC receipt and income in one model, and use of inpatient hospice care in the other model.…”

Section: Methodsmentioning

confidence: 99%

“…Only 2 studies have examined the association between use of CHC and subsequent end-of-life care. 1011 One study reported that patients using CHC were less likely to be transferred from home to another location before death, 10 and the other study reported that patients using CHC were less likely to die in an inpatient hospice setting. 11 Both studies were conducted with small, selected samples of hospices; furthermore, we could find no studies that have examined the association between CHC and hospice disenrollment or hospitalization after hospice enrollment.…”

Section: Introductionmentioning

confidence: 99%

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Continuous Home Care Reduces Hospice Disenrollment and Hospitalization After Hospice Enrollment

Wang

Aldridge

Canavan

et al. 2016

Journal of Pain and Symptom Management

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Objectives To identify hospice and patient characteristics associated with the use of continuous home care (CHC), and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment. Methods Using 100% fee-for-service Medicare claims data for beneficiaries aged 66 years or older who died between July and December 2011, we identified the percentage of hospice agencies in which patients used CHC in 2011 and determined hospice and patient characteristics associated with use of CHC. Using multivariable analyses, we examined the associations between CHC utilization and hospice disenrollment and hospitalization after hospice enrollment, adjusted for hospice and patient characteristics. Results Only 42.7% of hospices (1,533 out of 3,592 hospices studied) provided CHC to at least 1 patient during the study period. Patients enrolled with for-profit, larger, and urban located hospices were more likely to use CHC (P-values < 0.001). Within these 1,533 hospices, only 11.4% of patients used CHC. Patients who were white, had cancer, and had more comorbidities were more likely to use CHC. In multivariable models, compared with patients who did not use CHC, patients who used CHC were less likely to have hospice disenrollment (adjusted odds ratio [AOR]: 0.21, 95% confidence interval [CI]: 0.19-0.23) and less likely to be hospitalized after hospice enrollment (AOR: 0.37, 95% CI: 0.34-0.40). Conclusions Although a minority of patients uses CHC, such services may be protective against hospice disenrollment and hospitalization after hospice enrollment.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Continuous Home Care Reduces Hospice Disenrollment and Hospitalization After Hospice Enrollment

Wang

Aldridge

Canavan

et al. 2016

Journal of Pain and Symptom Management

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“…In this study, we found that hospices that provided CHC services had lower rates of hospice disenrollment or hospitalization than hospices which did not provide CHC services. Previous evidence has suggested that within CHC hospices, hospice enrollees who use CHC services may have better outcomes, including a decrease in hospice disenrollment or hospitalization at the end of life 11–13 . Prior studies, however, analyzed data of CHC hospice enrollees only and were unable to examine whether hospice’s offering of CHC may mitigate risks of disenrollment and hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…During a 24-hour day, the hospice must provide a minimum of 8 hours of nursing, hospice aide, and/or homemaker care, and the services provided must be predominantly nursing care 9 . Although studies have found that patients who use CHC are less likely to disenroll or be hospitalized in last 6 months of life 11–13 , no studies have examined whether hospices that offer CHC (CHC hospices) compared to those do not (non-CHC hospices) differ in terms of disenrollment and post-hospice hospitalization rates. Furthermore, we do not know how the effect of CHC provision may differ for larger and smaller hospices.…”

Section: Introductionmentioning

confidence: 99%

Associations of Hospice Disenrollment and Hospitalization With Continuous Home Care Provision

et al. 2017

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Objectives To examine rates of hospice disenrollment and post-hospice hospitalization among patients that are enrolled in hospices that provide CHC (CHC hospices) compared with patients who are enrolled in hospices that do not offer CHC (non-CHC hospices). Methods We performed a retrospective cohort study among Medicare fee-for-service decedents between July and December 2011, who were 66 years and older and had used hospice in their last 6 months of life. We used propensity score matching to account for potential confounding characteristics of hospices. Generalized estimating equation models were applied to estimate between CHC hospices and non-CHC hospices the associations of hospice disenrollment/hospitalization, adjusted for patient characteristics. We also conducted subgroup analyses to examine how the association might have differed by hospice size, and by the percentage of enrollees who received CHC. Results After matching, we identified 936 pairs of CHC and non-CHC hospices, well balanced in terms of organizational characteristics. In fully adjusted models, compared with non-CHC hospices, CHC hospices had significantly lower disenrollment rates (adjusted rate ratio [ARR]: 0.73, 95% confidence interval [CI]: 0.60–0.87), and lower hospitalization rates (ARR: 0.79, 95% CI 0.66–0.95). These associations were significantly more pronounced among larger hospices (those with more than 175 enrollees during study period), and among hospices in which at least 7.3% of enrollees used CHC. Conclusions CHC hospices had significantly lower rates of hospice disenrollment and post-hospice hospitalization, suggesting CHC service available may enable higher quality of end-of-life care.

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“…Furthermore, the patients referred to our program were younger and were more likely to have Medicaid or no insurance, characteristics that have been shown to be correlated with decreased use of hospice services and/or increased likelihood of in-hospital death in prior studies. [34][35][36][37] It is also possible that physicians who referred patients to the CARE Track program had a practice pattern of less aggressive care and early hospice referral as well. However, controlling for tumor type did not alter the differences between groups, and in this academic setting controlling for tumor type essentially controlled for provider as well.…”

Section: Figmentioning

confidence: 99%

CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic

Blackhall

Read

Stukenborg

et al. 2016

Journal of Palliative Medicine

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Background: Studies suggest that outpatient palliative care can reduce hospitalization and increase hospice utilization for patients with cancer, however there are insufficient resources to provide palliative care to all patients from time of diagnosis. It is also unclear whether inpatient consultation alone provides similar benefits. A better understanding of the timing, setting, and impact of palliative care for patients with cancer is needed. Objectives: The purpose of this study was to measure timing of referral to outpatient palliative care and impact on end-of-life (EOL) care. Design: The Comprehensive Assessment with Rapid Evaluation and Treatment (CARE Track) program is a phased intervention integrating outpatient palliative care into cancer care. In Year 1 patients were referred at the discretion of their oncologist. Setting: Academic medical center. Measurements: We compared EOL hospitalization, hospice utilization, and costs of care for CARE Track patients compared to those never seen by palliative care or seen only in hospital. Results: Patients were referred a median of 72.5 days prior to death. CARE Track patients had few hospitalizations at end of life, were less likely to die in hospital, had increased hospice utilization, and decreased costs of care; these results were significant even after controlling for differences between groups. Inpatient consultation alone did not impact these variables. However, only approximately half of patients with incurable cancers were referred to this program. Conclusion: Referral outpatient palliative care within 3 months of death improved EOL care and reduced costs, benefits not seen with inpatient care only. However, many patients were never referred, and methods of systematically identifying appropriate patients are needed.

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Association of Hospice Patients' Income and Care Level With Place of Death

Cited by 58 publications

References 45 publications

Continuous Home Care Reduces Hospice Disenrollment and Hospitalization After Hospice Enrollment

Continuous Home Care Reduces Hospice Disenrollment and Hospitalization After Hospice Enrollment

Associations of Hospice Disenrollment and Hospitalization With Continuous Home Care Provision

CARE Track for Advanced Cancer: Impact and Timing of an Outpatient Palliative Care Clinic

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