Continuous Home Care Reduces Hospice Disenrollment and Hospitalization After Hospice Enrollment

Abstract

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.

Association Between Nursing Visits and Hospital-Related Disenrollment in the Home Hospice Population

“…Our results build upon and support a previous study that found CHC reduced hospice disenrollment and hospitalization. 11 Our findings reiterate that the use of CHC or GIP care by hospices is associated with a reduction in odds of a hospitalrelated disenrollment. Further research is needed to understand how to best utilize and promote these resources when they are needed.…”

Health-Care Utilization After Hospice Enrollment in Patients With Heart Failure and Cancer

“…Evidence exists that the provision of continuous home care decreases the number of hospitalizations in hospice patients, but other interventions for decreasing acute care use should be evaluated. 32 We were surprised to note that almost a fifth of hospice patients in our sample lacked an advance directive. While hospice is often seen as a choice against pursuing aggressive care, we are not certain that all patients and families understand that or have reached consensus on that point.…”

Associations of Hospice Disenrollment and Hospitalization With Continuous Home Care Provision

“…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.…”

“…Literature suggested that the percentage of hospice enrollees who received CHC differed substantially across CHC hospices and, in some hospices, exceeded 75% 13, 22 . There have been concerns about overuse of healthcare services in the United States 23 ; and there have been potential fraud hospice claims 24 .…”

“…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.…”