Differences between patients referred to hospice from academic vs. non-academic settings.

Hospice is designed to provide end-of-life care to patients who are terminally ill. Increasingly, hospices are developing affiliations with academic medical centers. However, little is known about this group of patients, and how their needs may differ from those of the general population of hospice patients. To identify differences between patients referred to an urban, non-profit hospice from academic vs. non-academic medical centers, a retrospective cohort study of 1,691 patients admitted to an inpatient and outpatient hospice program was conducted. Admission dates were between January 1997 and January 1999, and data were gathered until discharge or death. The major outcome of interest was the need for nursing interventions at the time of entry into hospice. Patients referred from academic medical centers were younger, had higher incomes, and were less likely to have Medicare or Medicaid. Patients referred from academic medical centers were less likely to have a Do Not Resuscitate order or a living will, and had more medical and nursing needs. Survival analysis revealed no difference in length of stay between patients referred from academic and non-academic medical centers. Patients referred to hospice from academic medical centers have greater needs for nursing and medical care than do patients referred from non-academic medical centers. The implications of these findings for policy are discussed.