The new issue of The Journal of Palliative Medicine contains an article on a research study out of Brown University, School of Public Health, Center for Gerontology and Healthcare Research looking at live discharges among hospices in the U.S. The study was led by Joan M. Teno, MD, MS, Michael Plotzke, PhD, Pedro Gozalo, PhD, and Vincent More, PhD.
The article abstract on the retrospective cohort study is available online and says in part:
Live discharges from hospice can occur because patients decide to resume curative care, their condition improves, or hospices may inappropriately use live discharge to avoid costly hospitalizations..
In 2010, 182,172 of 1,003,958 (18.2%) hospice discharges were alive. Hospice rate of live discharges varied by hospice program with interquartile range of 9.5% to 26.4% and by geographic regions with the lowest rate in Connecticut (12.8%) and the highest in Mississippi (40.5%). Approximately 1 in 4 (n=43,889; 24.1%) beneficiaries discharged alive were hospitalized within 30 days. Nearly 8% (n=13,770) had a pattern of hospice discharge, hospitalization, and hospice readmission. These latter cases account for $126 million in Medicare reimbursement. Not-for-profit hospice programs had a lower rate of live discharges compared to for-profit programs (14.6% versus 22.4%; adjusted odds ratio [AOR] 0.84, 95% confidence interval [CI] 0.77–0.91). More mature hospice programs (over 21 years in operation) had lower rates of live discharge compared to programs in operation for 5 years or less (14.2% versus 26.7%; AOR 0.71, 95% CI 0.65–0.77). Small for-profits in operation 5 years or less had a higher live discharge rate than older, for-profit programs (31.5% versus 14.3%, p<0.001). Conclusions: Approximately 1 in 5 hospice patients are discharged alive with variation by geographic regions and hospice programs. Not-for-profit hospices and older hospices have lower rates of live discharge.
Read the abstract at: http://online.liebertpub.com/doi/full/10.1089/jpm.2013.0595.
The National Hospice and Palliative Care Organization offered some comments: “Live discharges have always been seen within hospice care in the U.S. Live discharges from hospice can occur because patients decide to resume curative care, their condition improves or stabilizes, or a patient leaves hospice care for other personal reasons that can vary. As the author’s note, ‘Given the uncertainties of prognostications and the need to ensure access to high-quality care, it would be undesirable if the rate of live discharge were zero.’ It is to be expected that some patients leave hospice care. But some of the research findings point to problems among a small percentage of providers in the field, and it is important to use the data constructively.”
Read the complete NHPCO statement (08/07/14).