Variation in hospice patient and admission characteristics by referral location

Jon P. Furuno, Brie N. Noble, Mary L. McPherson, Kate L. Lapane, Leah Sera, Shigeko Izumi, Jennifer Tjia

Research output: Contribution to journalArticlepeer-review


Background: Little is known regarding differences between patients referred to hospice from different care locations. Objective: The objective this study was to describe the associations between hospice referral locations and hospice patient and admission characteristics. Research Design: Cross-sectional analysis of hospice administrative data. Subjects: Adult (age older than 18 y) decedents of a national, for-profit, hospice chain across 19 US states who died between January 1, 2012, and December 31, 2016. Measures: Patients' primary hospice diagnosis, hospice length stay, and hospice care site. We also determined the frequency of opioid prescriptions with and without a bowel regimen on hospice admission. Results: Among 78,647 adult decedents, the mean age was 79.2 (SD=13.5) years, 56.4% were female, and 69.9% were a non-Hispanic White race. Most hospice referrals were from the hospital (51.9%), followed by the community (21.9%), nursing homes (17.4%), and assisted living (8.8%). Cancer (33.6%) was the most prevalent primary hospice diagnosis; however, this varied significantly between referral locations (P<0.001). Similarly, home hospice (32.8%) was the most prevalent site; however, this also varied significantly between referral locations (P<0.001). More hospital-referred patients (55.6%) had a hospice length of stay <7 days compared with patients referred from nursing homes (30.3%), the community (28.9%), or assisted living (18.7%), P<0.001. Hospital-referred patients also had the lowest frequency (58.4%) of coprescribed opioids and bowel regimen on hospice admission compared with other referral locations. Conclusion: We observed significant differences in hospice patient and admission characteristics by referral location.

Original languageEnglish (US)
JournalMedical care
StateAccepted/In press - 2020


  • hospice care
  • referral source
  • transitions of care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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