The impact of reported hospice preferred practices on hospital utilization at the end of life

Melissa D. Aldridge, Andrew J. Epstein, Abraham Brody, Eric J. Lee, Emily Cherlin, Elizabeth H. Bradley

Research output: Contribution to journalArticle

Abstract

Background: The Affordable Care Act requires hospices to report quality measures across a range of processes and practices. Yet uncertainties exist regarding the impact of hospice preferred practices on patient outcomes. Objective: Assess the impact of 6 hospice preferred practices and hospice organizational characteristics on hospital utilization and death using the first national data on hospice preferred practices. Design: Longitudinal cohort study (2008-2011) of Medicare beneficiaries (N=149,814) newly enrolled in a national random sample of hospices (N=577) from the National Hospice Survey (84% response rate) and followed until death. Outcome Measures: The proportion of patients at each hospice admitted to the hospital, emergency department (ED), and intensive care unit (ICU), and who died in the hospital after hospice enrollment. Results: Hospices that reported assessing patient preferences for site of death at admission had lower odds of being in the highest quartile for hospital death (AOR=0.36; 95% CI, 0.14-0.93) and ED visits (AOR=0.27; 95% CI, 0.10-0.76). Hospices that reported more frequently monitoring symptoms had lower odds of being in the highest quartile for ICU stays (AOR=0.48; 95% CI, 0.24-0.94). In adjusted analyses, a higher proportion of patients at for-profit compared with nonprofit hospices experienced a hospital admission (15.3% vs. 10.9%, P

Original languageEnglish (US)
Pages (from-to)657-663
Number of pages7
JournalMedical Care
Volume54
Issue number7
DOIs
StatePublished - Jul 1 2016

Fingerprint

Hospices
Intensive Care Units
Hospital Emergency Service
Patient Protection and Affordable Care Act
Patient Preference
Hospital Departments
Emergency Medical Services
Medicare
Uncertainty
Longitudinal Studies
Cohort Studies
Outcome Assessment (Health Care)

Keywords

  • end of life care
  • end of life hospitalization
  • end of life intensity
  • hospice
  • hospice preferred practices
  • transitions

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

The impact of reported hospice preferred practices on hospital utilization at the end of life. / Aldridge, Melissa D.; Epstein, Andrew J.; Brody, Abraham; Lee, Eric J.; Cherlin, Emily; Bradley, Elizabeth H.

In: Medical Care, Vol. 54, No. 7, 01.07.2016, p. 657-663.

Research output: Contribution to journalArticle

Aldridge, Melissa D. ; Epstein, Andrew J. ; Brody, Abraham ; Lee, Eric J. ; Cherlin, Emily ; Bradley, Elizabeth H. / The impact of reported hospice preferred practices on hospital utilization at the end of life. In: Medical Care. 2016 ; Vol. 54, No. 7. pp. 657-663.
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