Cost, quality, and satisfaction with hospice after-hours care.

Three hundred seventy-three patients enrolled in a health maintenance organization's hospice program were given two different models of after-hours nursing care, one using nurse employees and the other using contract nurses. Statistically significant differences were found between the two groups in cost, in quality of nursing care, and in patient/family satisfaction. Cost of hospital days for the organization was less when patients received after-hours care from nurse employees of the organization, and quality of documentation was better. More patients who received care from nurse employees were satisfied with nurses' arrival time and understanding of problems as well as with the service, information, courtesy, follow-up, and respect which patients received during their hospice stay.