Are Trends in Hospitalization Prior to Hospice Use Associated With Hospice Episode Characteristics?

Journal Article (Journal Article)

This study expands current knowledge of factors associated with initiation of hospice care by examining prehospice patterns of medical care leading to Medicare hospice use and the relationships to hospice episode characteristics. Data from the Atherosclerosis Risk in Communities (ARIC) study cohort offer the ability to control for measures that are not available in Medicare claims data, including marital status, nursing home residency, and education. For 1248 ARIC participants who used hospice (2006-2012), participant level trends in the number of hospital days per 30-day period over the year prior to hospice initiation were generated using a fixed-effects model. Logistic regression was used to estimate the associations between increasing hospital use over the year prior to hospice enrollment with key patient characteristics (diagnosis, age, and comorbidity) and episode characteristics (short hospice stay ending in death, long hospice stay, and live discharge). Participants with severe comorbidity (measured as a Charlson comorbidity index score greater than 5) had higher odds of increasing hospital use prior to hospice (odds ratio [OR] = 3.28, confidence interval [CI] = 2.25-4.78). Increasing hospital use did not vary by diagnosis but was associated with reduced odds of a live hospice discharge (OR = 0.55, CI = 0.34-0.88) or long stay in hospice (OR = 0.44, CI = 0.24-0.79) and increased odds of a short stay in hospice (OR = 1.92, CI = 1.36-2.71). The evidence that care patterns prior to hospice use are associated with hospice outcomes could facilitate development of interventions to improve timely hospice referral.

Full Text

Duke Authors

Cited Authors

  • Kaufman, BG; Sueta, CA; Chen, C; Windham, BG; Stearns, SC

Published Date

  • November 2017

Published In

Volume / Issue

  • 34 / 9

Start / End Page

  • 860 - 868

PubMed ID

  • 27418598

Pubmed Central ID

  • PMC6176480

Electronic International Standard Serial Number (EISSN)

  • 1938-2715

Digital Object Identifier (DOI)

  • 10.1177/1049909116659049


  • eng

Conference Location

  • United States