Joan M Teno1, Jason Bowman2, Michael Plotzke3, Pedro L Gozalo2, Thomas Christian3, Susan C Miller2, Cindy Williams2, Vincent Mor2. 1. Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA. Electronic address: Joan_Teno@brown.edu. 2. Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA. 3. Abt Associates, Cambridge, Massachusetts, USA.
Abstract
CONTEXT: Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. OBJECTIVES: To characterize hospices with high rates of problematic patterns of live discharges. METHODS: Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located. RESULTS: In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers. CONCLUSION: Problematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain.
CONTEXT: Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. OBJECTIVES: To characterize hospices with high rates of problematic patterns of live discharges. METHODS: Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located. RESULTS: In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers. CONCLUSION: Problematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain.
Authors: Veerawat Phongtankuel; Ronald D Adelman; Kelly Trevino; Erika Abramson; Phyllis Johnson; Clara Oromendia; Charles R Henderson; M C Reid Journal: Am J Hosp Palliat Care Date: 2017-03-13 Impact factor: 2.500
Authors: Veerawat Phongtankuel; P Johnson; M C Reid; R D Adelman; Z Grinspan; M A Unruh; E Abramson Journal: Am J Hosp Palliat Care Date: 2016-07-22 Impact factor: 2.500
Authors: Elizabeth A Luth; David J Russell; Jiehui Cici Xu; Bonnie Lauder; Miriam B Ryvicker; Ritchell R Dignam; Rosemary Baughn; Kathryn H Bowles; Holly G Prigerson Journal: J Am Geriatr Soc Date: 2021-02-19 Impact factor: 7.538