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- Title
Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice.
- Authors
Luth, Elizabeth A.; Brennan, Caitlin; Hurley, Susan L.; Phongtankuel, Veerawat; Prigerson, Holly G.; Ryvicker, Miriam; Shao, Hui; Zhang, Yongkang
- Abstract
Key Points: Question: What factors are associated with burdensome transitions 2 days after live hospice discharge? Findings: This cohort study of 115 072 Medicare fee-for-service beneficiaries from 2014 to 2019 found that 9% of individuals discharged alive from hospice were hospitalized and readmitted to hospice and 3% were hospitalized and died in the hospital. Identifying as Black, having a short hospice stay, and receiving care from a for-profit hospice were associated with higher odds of burdensome transition. Meaning: These findings suggest that clinical practice and policy should attend to patients at greater risk for burdensome transitions after hospice live discharge, including systematic, incentivized discharge planning tailored to individual patient needs. This cohort study assesses patient, health care, and organizational factors associated with hospice readmission, hospitalization, and in-hospital mortality among Medicare fee-for-service beneficiaries discharged alive from hospice. Importance: Transitions in care settings following live discharge from hospice care are burdensome for patients and families. Factors contributing to risk of burdensome transitions following hospice discharge are understudied. Objective: To identify factors associated with 2 burdensome transitions following hospice live discharge, as defined by the Centers for Medicare & Medicaid Services. Design, Setting, and Participants: This population-based retrospective cohort study included a 20% random sample of Medicare fee-for-service beneficiaries using 2014 to 2019 Medicare claims data. Data were analyzed from April 22, 2023, to March 4, 2024. Exposure: Live hospice discharge. Main Outcomes and Measures: Multivariable logistic regression examined associations among patient, health care provision, and organizational characteristics with 2 burdensome transitions after live hospice discharge (outcomes): type 1, hospice discharge, hospitalization within 2 days, and hospice readmission within 2 days; and type 2, hospice discharge, hospitalization within 2 days, and hospital death. Results: This study included 115 072 Medicare beneficiaries discharged alive from hospice (mean [SD] age, 84.4 [6.6] years; 71892 [62.5%] female; 5462 [4.8%] Hispanic, 9822 [8.5%] non-Hispanic Black, and 96 115 [83.5%] non-Hispanic White). Overall, 10 381 individuals (9.0%) experienced a type 1 burdensome transition and 3144 individuals (2.7%) experienced a type 2 burdensome transition. In adjusted models, factors associated with higher odds of burdensome transitions included identifying as non-Hispanic Black (type 1: adjusted odds ratio [aOR], 1.47; 95% CI, 1.36-1.58; type 2: aOR, 1.70; 95% CI, 1.51-1.90), hospice stays of 7 days or fewer (type 1: aOR, 1.13; 95% CI, 1.06-1.21; type 2: aOR, 1.71; 95% CI, 1.53-1.90), and care from a for-profit hospice (type 1: aOR, 1.78; 95% CI, 1.62-1.96; type 2: aOR, 1.32; 95% CI, 1.15-1.52). Nursing home residence (type 1: aOR, 0.66; 95% CI, 0.61-0.72; type 2: aOR, 0.47; 95% CI, 0.40-0.54) and hospice stays of 180 days or longer (type 1: aOR, 0.63; 95% CI, 0.59-0.68; type 2: aOR, 0.60; 95% CI, 0.52-0.69) were associated with lower odds of burdensome transitions. Conclusion and Relevance: This retrospective cohort study of burdensome transitions following live hospice discharge found that non-Hispanic Black race, short hospice stays, and care from for-profit hospices were associated with higher odds of experiencing a burdensome transition. These findings suggest that changes to clinical practice and policy may reduce the risk of burdensome transitions, such as hospice discharge planning that is incentivized, systematically applied, and tailored to needs of patients at greater risk for burdensome transitions.
- Subjects
RISK assessment; CENTERS for Medicare &; Medicaid Services (U.S.); RESEARCH funding; T-test (Statistics); HOSPITAL care; PATIENT readmissions; MULTIPLE regression analysis; SEX distribution; STATISTICAL sampling; HOSPITAL mortality; DISCHARGE planning; RETROSPECTIVE studies; AGE distribution; DESCRIPTIVE statistics; CHI-squared test; LONGITUDINAL method; ODDS ratio; RACE; MEDICAL records; ACQUISITION of data; CONFIDENCE intervals; LENGTH of stay in hospitals; DATA analysis software; SOCIODEMOGRAPHIC factors; CONGREGATE housing; HOSPICE care
- Publication
JAMA Network Open, 2024, Vol 7, Issue 5, pe2411520
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.11520