Nina R O'Connor1, Rong Hu1, Pamela S Harris1, Kevin Ache1, David J Casarett2. 1. Nina R. O'Connor, Rong Hu, David J. Casarett, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Pamela S. Harris, Kansas City Hospice and Palliative Care, Kansas City, MO; Kevin Ache, Suncoast Hospice, Clearwater, FL. 2. Nina R. O'Connor, Rong Hu, David J. Casarett, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Pamela S. Harris, Kansas City Hospice and Palliative Care, Kansas City, MO; Kevin Ache, Suncoast Hospice, Clearwater, FL. Casarett@mail.med.upenn.edu.
Abstract
PURPOSE: To define patient characteristics associated with hospice enrollment in the last 3 days of life, and to describe adjusted proportions of patients with late referrals among patient subgroups that could be considered patient-mix adjustment variables for this quality measure. METHODS: Electronic health record-based retrospective cohort study of patients with cancer admitted to 12 hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. RESULTS: Of 64,264 patients admitted to hospice with cancer, 10,460 (16.3%) had a length of stay ≤ 3 days. There was significant variation among hospices (range, 11.4% to 24.5%). In multivariable analysis, among patients referred to hospice, patients who were admitted in the last 3 days of life were more likely to have a hematologic malignancy, were more likely to be male and married, and were younger (age < 65 years). Patients with Medicaid or self-insurance were less likely to be admitted to hospice within 3 days of death. CONCLUSION: Quality measures of hospice lengths of stay should include patient-mix adjustments for type of cancer and site of care. Patients with hematologic malignancies are at especially increased risk for late admission to hospice.
PURPOSE: To define patient characteristics associated with hospice enrollment in the last 3 days of life, and to describe adjusted proportions of patients with late referrals among patient subgroups that could be considered patient-mix adjustment variables for this quality measure. METHODS: Electronic health record-based retrospective cohort study of patients with cancer admitted to 12 hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. RESULTS: Of 64,264 patients admitted to hospice with cancer, 10,460 (16.3%) had a length of stay ≤ 3 days. There was significant variation among hospices (range, 11.4% to 24.5%). In multivariable analysis, among patients referred to hospice, patients who were admitted in the last 3 days of life were more likely to have a hematologic malignancy, were more likely to be male and married, and were younger (age < 65 years). Patients with Medicaid or self-insurance were less likely to be admitted to hospice within 3 days of death. CONCLUSION: Quality measures of hospice lengths of stay should include patient-mix adjustments for type of cancer and site of care. Patients with hematologic malignancies are at especially increased risk for late admission to hospice.
Authors: Elizabeth K Vig; Helene Starks; Janelle S Taylor; Elizabeth K Hopley; Kelly Fryer-Edwards Journal: J Gen Intern Med Date: 2010-06-10 Impact factor: 5.128
Authors: Amber E Barnato; M Brooke Herndon; Denise L Anthony; Patricia M Gallagher; Jonathan S Skinner; Julie P W Bynum; Elliott S Fisher Journal: Med Care Date: 2007-05 Impact factor: 2.983
Authors: Donald H Taylor; Jan Ostermann; Courtney H Van Houtven; James A Tulsky; Karen Steinhauser Journal: Soc Sci Med Date: 2007-06-27 Impact factor: 4.634
Authors: Nancy L Keating; Lisa J Herrinton; Alan M Zaslavsky; Liyan Liu; John Z Ayanian Journal: J Natl Cancer Inst Date: 2006-08-02 Impact factor: 13.506
Authors: Alexi A Wright; Nancy L Keating; Tracy A Balboni; Ursula A Matulonis; Susan D Block; Holly G Prigerson Journal: J Clin Oncol Date: 2010-09-13 Impact factor: 44.544
Authors: Jonathan Bergman; Christopher S Saigal; Karl A Lorenz; Janet Hanley; David C Miller; John L Gore; Mark S Litwin Journal: Arch Intern Med Date: 2010-10-11
Authors: Craig C Earle; Mary Beth Landrum; Jeffrey M Souza; Bridget A Neville; Jane C Weeks; John Z Ayanian Journal: J Clin Oncol Date: 2008-08-10 Impact factor: 44.544
Authors: Jennifer S Haas; Craig C Earle; John E Orav; Phyllis Brawarsky; Bridget A Neville; Dolores Acevedo-Garcia; David R Williams Journal: J Gen Intern Med Date: 2007-03 Impact factor: 5.128
Authors: Elie K Mehanna; Paul J Catalano; Daniel N Cagney; Daphne A Haas-Kogan; Brian M Alexander; James A Tulsky; Ayal A Aizer Journal: J Natl Cancer Inst Date: 2020-12-14 Impact factor: 13.506
Authors: Davide Gori; Rajendra Dulal; Douglas W Blayney; James D Brooks; Maria P Fantini; Kathryn M McDonald; Tina Hernandez-Boussard Journal: Jt Comm J Qual Patient Saf Date: 2018-09-18
Authors: Catherine Henckel; Anna Revette; Scott F Huntington; James A Tulsky; Gregory A Abel; Oreofe O Odejide Journal: J Pain Symptom Manage Date: 2020-01-09 Impact factor: 3.612
Authors: Catherine Saiki; Betty Ferrell; Denise Longo-Schoeberlein; Vincent Chung; Thomas J Smith Journal: J Community Support Oncol Date: 2017 Jul-Aug
Authors: Sushma Jonna; Leslie Chiang; Jingxia Liu; Maria B Carroll; Kellie Flood; Tanya M Wildes Journal: Support Care Cancer Date: 2016-07-27 Impact factor: 3.603