Characteristics of Hospice Programs with Problematic Live Discharges

Joan Teno, Jason Bowman, Michael Plotzke, Pedro L. Gozalo, Thomas Christian, Susan C. Miller, Cindy Williams, Vincent Mor

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Context Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. Objectives To characterize hospices with high rates of problematic patterns of live discharges. Methods Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located. Results In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers. Conclusion Problematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain.

Original languageEnglish (US)
Pages (from-to)548-552
Number of pages5
JournalJournal of Pain and Symptom Management
Volume50
Issue number4
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

Fingerprint

Hospice Care
Hospices
Taxes
Logistic Models

Keywords

  • for-profit
  • hospice chain affiliation
  • Hospices
  • live discharges
  • not-for-profit

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Teno, J., Bowman, J., Plotzke, M., Gozalo, P. L., Christian, T., Miller, S. C., ... Mor, V. (2015). Characteristics of Hospice Programs with Problematic Live Discharges. Journal of Pain and Symptom Management, 50(4), 548-552. https://doi.org/10.1016/j.jpainsymman.2015.05.001

Characteristics of Hospice Programs with Problematic Live Discharges. / Teno, Joan; Bowman, Jason; Plotzke, Michael; Gozalo, Pedro L.; Christian, Thomas; Miller, Susan C.; Williams, Cindy; Mor, Vincent.

In: Journal of Pain and Symptom Management, Vol. 50, No. 4, 01.10.2015, p. 548-552.

Research output: Contribution to journalArticle

Teno, J, Bowman, J, Plotzke, M, Gozalo, PL, Christian, T, Miller, SC, Williams, C & Mor, V 2015, 'Characteristics of Hospice Programs with Problematic Live Discharges', Journal of Pain and Symptom Management, vol. 50, no. 4, pp. 548-552. https://doi.org/10.1016/j.jpainsymman.2015.05.001
Teno, Joan ; Bowman, Jason ; Plotzke, Michael ; Gozalo, Pedro L. ; Christian, Thomas ; Miller, Susan C. ; Williams, Cindy ; Mor, Vincent. / Characteristics of Hospice Programs with Problematic Live Discharges. In: Journal of Pain and Symptom Management. 2015 ; Vol. 50, No. 4. pp. 548-552.
@article{b46e57b8509442e587a10b3aa232e0c5,
title = "Characteristics of Hospice Programs with Problematic Live Discharges",
abstract = "Context Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. Objectives To characterize hospices with high rates of problematic patterns of live discharges. Methods Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located. Results In 2010, 3028 hospice programs had 996,208 discharges, with 18.0{\%} being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2{\%} vs. 12.1{\%}, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4{\%}). About one in three (33.8{\%}) for-profit providers exhibited one or more of these discharge patterns compared with 9.0{\%} of not-for-profit providers. Conclusion Problematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain.",
keywords = "for-profit, hospice chain affiliation, Hospices, live discharges, not-for-profit",
author = "Joan Teno and Jason Bowman and Michael Plotzke and Gozalo, {Pedro L.} and Thomas Christian and Miller, {Susan C.} and Cindy Williams and Vincent Mor",
year = "2015",
month = "10",
day = "1",
doi = "10.1016/j.jpainsymman.2015.05.001",
language = "English (US)",
volume = "50",
pages = "548--552",
journal = "Journal of Pain and Symptom Management",
issn = "0885-3924",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Characteristics of Hospice Programs with Problematic Live Discharges

AU - Teno, Joan

AU - Bowman, Jason

AU - Plotzke, Michael

AU - Gozalo, Pedro L.

AU - Christian, Thomas

AU - Miller, Susan C.

AU - Williams, Cindy

AU - Mor, Vincent

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Context Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. Objectives To characterize hospices with high rates of problematic patterns of live discharges. Methods Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located. Results In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers. Conclusion Problematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain.

AB - Context Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. Objectives To characterize hospices with high rates of problematic patterns of live discharges. Methods Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located. Results In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers. Conclusion Problematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain.

KW - for-profit

KW - hospice chain affiliation

KW - Hospices

KW - live discharges

KW - not-for-profit

UR - http://www.scopus.com/inward/record.url?scp=84942984426&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84942984426&partnerID=8YFLogxK

U2 - 10.1016/j.jpainsymman.2015.05.001

DO - 10.1016/j.jpainsymman.2015.05.001

M3 - Article

VL - 50

SP - 548

EP - 552

JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

SN - 0885-3924

IS - 4

ER -