Why Don’t Patients Enroll in Hospice? Can We Do Anything About It?

Vig, Elizabeth K.; Starks, Helene; Taylor, Janelle S.; Hopley, Elizabeth K.; Fryer‐Edwards, Kelly

doi:10.1007/s11606-010-1423-9

Cited by 50 publications

(75 citation statements)

References 33 publications

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“…6 Within developed nations, palliative care services have been found to improve patient and family outcomes, 7 and hospice has emerged as a model for the provision of optimal endof-life care. 8 Although hospice and palliative care services can reduce suffering, these services remain under-used. Despite eligibility for a specialized hospice insurance benefit for those with a life expectancy of less than sixmonths, it is well known among palliative care providers and researchers that most terminally ill persons do not initiate comfort-focused care until very late in the dying trajectory.…”

Section: Introductionmentioning

confidence: 99%

Contending With Advanced Illness: Patient and Caregiver Perspectives

Meeker

Waldrop

Schneider

et al. 2014

Journal of Pain and Symptom Management

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Section: Introductionmentioning

confidence: 99%

Contending With Advanced Illness: Patient and Caregiver Perspectives

Meeker

Waldrop

Schneider

et al. 2014

Journal of Pain and Symptom Management

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“…Primary care physicians may hesitate to refer to hospice if doing so is perceived as terminating a long-standing relationship. 22 Alternatively, primary care physicians may not recognize patients as having a prognosis of less than 6 months because of their longstanding relationship. 23 Finally, hospice growth may be concentrated in regions where primary care physicians are not as predominant a source of care.…”

Section: Discussionmentioning

confidence: 99%

“…22 Long duration of relationship had been reported to decrease prognostic accuracy, thereby reducing the ability of physicians to identify patients with 6-month life expectancies. 23 Given our aging population, understanding and optimizing the role of primary care physicians in care at the end of life is critical to both improve the care of the dying and reduce unnecessary, costly intensive care.…”

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confidence: 99%

Regional Variation in Primary Care Involvement at the End of Life

et al. 2017

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PURPOSE Variation in end-of-life care in the United States is frequently driven by the health care system. We assessed the association of primary care physician involvement at the end of life with end-of-life care patterns. METHODSWe analyzed 2010 Medicare Part B claims data for US hospital referral regions (HRRs). The independent variable was the ratio of primary care physicians to specialist visits in the last 6 months of life. Dependent variables included the rate of hospital deaths, hospital and intensive care use in the last 6 months of life, percentage of patients seen by more than 10 physicians, and Medicare spending in the last 2 years of life. Robust linear regression analysis was used to measure the association of primary care physician involvement at the end of life with the outcome variables, adjusting for regional characteristics. RESULTSWe assessed 306 HRRs, capturing 1,107,702 Medicare Part B beneficiaries with chronic disease who died. The interquartile range of the HRR ratio of primary care to specialist end-of-life visits was 0.77 to 1.21. HRRs with high vs low primary care physician involvement at the end of life had significantly different patient, population, and health system characteristics. Adjusting for these differences, HRRs with the greatest primary care physician involvement had lower Medicare spending in the last 2 years of life ($65,160 vs $69,030; P = .003) and fewer intensive care unit days in the last 6 months of life (2.90 vs 4.29; P <.001), but also less hospice enrollment (44.5% of decedents vs 50.4%; P = .004).CONCLUSIONS Regions with greater primary care physician involvement in endof-life care have overall less intensive end-of-life care.

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“…three broad categories: patient and family perceptions, hospice-specific issues (variation in who is actually eligible), and systemic issues (such as worry about continuity of care;Vig, Starks, Taylor, Hopley, & Fryer-Edwards., 2010). Both variation in who is eligible and continuity of care can be related to the influence of Medicare eligibility and election.…”

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confidence: 99%

Hospice Eligibility and Election: Does Policy Prepare Us to Meet the Need?

Wallace

2015

Journal of Aging & Social Policy

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A 7-point policy model is used to examine policy on hospice eligibility and election in the United States. Despite the growth of hospice, many eligible patients continue to lack access due to difficulties experienced by providers in discerning 6-month prognoses among chronically ill patients, the inability of patients to elect hospice alongside curative care, and limited reimbursement for hospice providers. Though the landscape of dying has evolved, with more deaths occurring later in life from chronic illness, Medicare hospice eligibility requirements have historically remained the same. Utilization would increase if hospice agencies were able to provide fewer restrictions by including ongoing treatments such as transfusions, intravenous nutrition, or palliative radiation. Hospices would be more likely to enroll critically ill patients who require some ongoing curative measures if Medicare reimbursement rates were higher, and patients would be more likely to seek hospice earlier if Medicare election policies were altered to allow concurrent care. Participation would also be increased by extending hospice eligibility past the traditional prognosis of 6 months. Though expansion in public spending of hospice care has been met with some opposition, current research suggests that potential savings due to decreased costs in acute care is promising.

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Why Don’t Patients Enroll in Hospice? Can We Do Anything About It?

Cited by 50 publications

References 33 publications

Contending With Advanced Illness: Patient and Caregiver Perspectives

Contending With Advanced Illness: Patient and Caregiver Perspectives

Regional Variation in Primary Care Involvement at the End of Life

Hospice Eligibility and Election: Does Policy Prepare Us to Meet the Need?

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