A national study of live discharges from hospice

Joan Teno, Michael Plotzke, Pedro Gozalo, Vincent Mor

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

BACKGROUND: Live discharges from hospice can occur because patients decide to resume curative care, their condition improves, or hospices may inappropriately use live discharge to avoid costly hospitalizations.

OBJECTIVE: Describe the variation, outcomes, and organizational characteristics associated with live discharges.

DESIGN: Retrospective cohort study.

SETTING/SUBJECTS: Medicare fee-for-service hospice beneficiaries.

MEASUREMENT: Overall rate, timing, and health care transitions of live discharges.

RESULTS: In 2010, 182,172 of 1,003,958 (18.2%) hospice discharges were alive. Hospice rate of live discharges varied by hospice program with interquartile range of 9.5% to 26.4% and by geographic regions with the lowest rate in Connecticut (12.8%) and the highest in Mississippi (40.5%). Approximately 1 in 4 (n=43,889; 24.1%) beneficiaries discharged alive were hospitalized within 30 days. Nearly 8% (n=13,770) had a pattern of hospice discharge, hospitalization, and hospice readmission. These latter cases account for $126 million in Medicare reimbursement. Not-for-profit hospice programs had a lower rate of live discharges compared to for-profit programs (14.6% versus 22.4%; adjusted odds ratio [AOR] 0.84, 95% confidence interval [CI] 0.77-0.91). More mature hospice programs (over 21 years in operation) had lower rates of live discharge compared to programs in operation for 5 years or less (14.2% versus 26.7%; AOR 0.71, 95% CI 0.65-0.77). Small for-profits in operation 5 years or less had a higher live discharge rate than older, for-profit programs (31.5% versus 14.3%, p<0.001).

CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)1121-1127
Number of pages7
JournalJournal of palliative medicine
Volume17
Issue number10
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

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Hospices
Hospice Care
Medicare
Hospitalization
Odds Ratio
Confidence Intervals
Mississippi
Patient Transfer
Fee-for-Service Plans
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

Cite this

A national study of live discharges from hospice. / Teno, Joan; Plotzke, Michael; Gozalo, Pedro; Mor, Vincent.

In: Journal of palliative medicine, Vol. 17, No. 10, 01.10.2014, p. 1121-1127.

Research output: Contribution to journalArticle

Teno, Joan ; Plotzke, Michael ; Gozalo, Pedro ; Mor, Vincent. / A national study of live discharges from hospice. In: Journal of palliative medicine. 2014 ; Vol. 17, No. 10. pp. 1121-1127.
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abstract = "BACKGROUND: Live discharges from hospice can occur because patients decide to resume curative care, their condition improves, or hospices may inappropriately use live discharge to avoid costly hospitalizations.OBJECTIVE: Describe the variation, outcomes, and organizational characteristics associated with live discharges.DESIGN: Retrospective cohort study.SETTING/SUBJECTS: Medicare fee-for-service hospice beneficiaries.MEASUREMENT: Overall rate, timing, and health care transitions of live discharges.RESULTS: In 2010, 182,172 of 1,003,958 (18.2{\%}) hospice discharges were alive. Hospice rate of live discharges varied by hospice program with interquartile range of 9.5{\%} to 26.4{\%} and by geographic regions with the lowest rate in Connecticut (12.8{\%}) and the highest in Mississippi (40.5{\%}). Approximately 1 in 4 (n=43,889; 24.1{\%}) beneficiaries discharged alive were hospitalized within 30 days. Nearly 8{\%} (n=13,770) had a pattern of hospice discharge, hospitalization, and hospice readmission. These latter cases account for $126 million in Medicare reimbursement. Not-for-profit hospice programs had a lower rate of live discharges compared to for-profit programs (14.6{\%} versus 22.4{\%}; adjusted odds ratio [AOR] 0.84, 95{\%} confidence interval [CI] 0.77-0.91). More mature hospice programs (over 21 years in operation) had lower rates of live discharge compared to programs in operation for 5 years or less (14.2{\%} versus 26.7{\%}; AOR 0.71, 95{\%} CI 0.65-0.77). Small for-profits in operation 5 years or less had a higher live discharge rate than older, for-profit programs (31.5{\%} versus 14.3{\%}, p<0.001).CONCLUSIONS: 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.",
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AB - BACKGROUND: Live discharges from hospice can occur because patients decide to resume curative care, their condition improves, or hospices may inappropriately use live discharge to avoid costly hospitalizations.OBJECTIVE: Describe the variation, outcomes, and organizational characteristics associated with live discharges.DESIGN: Retrospective cohort study.SETTING/SUBJECTS: Medicare fee-for-service hospice beneficiaries.MEASUREMENT: Overall rate, timing, and health care transitions of live discharges.RESULTS: In 2010, 182,172 of 1,003,958 (18.2%) hospice discharges were alive. Hospice rate of live discharges varied by hospice program with interquartile range of 9.5% to 26.4% and by geographic regions with the lowest rate in Connecticut (12.8%) and the highest in Mississippi (40.5%). Approximately 1 in 4 (n=43,889; 24.1%) beneficiaries discharged alive were hospitalized within 30 days. Nearly 8% (n=13,770) had a pattern of hospice discharge, hospitalization, and hospice readmission. These latter cases account for $126 million in Medicare reimbursement. Not-for-profit hospice programs had a lower rate of live discharges compared to for-profit programs (14.6% versus 22.4%; adjusted odds ratio [AOR] 0.84, 95% confidence interval [CI] 0.77-0.91). More mature hospice programs (over 21 years in operation) had lower rates of live discharge compared to programs in operation for 5 years or less (14.2% versus 26.7%; AOR 0.71, 95% CI 0.65-0.77). Small for-profits in operation 5 years or less had a higher live discharge rate than older, for-profit programs (31.5% versus 14.3%, p<0.001).CONCLUSIONS: 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.

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