Veerawat Phongtankuel1,2, Ronald D Adelman1,2, Kelly Trevino1,2, Erika Abramson2,3,4, Phyllis Johnson3, Clara Oromendia3, Charles R Henderson5, M C Reid1,2. 1. 1 Department of Medicine, Weill Cornell Medicine, New York, NY, USA. 2. 2 New York-Presbyterian Hospital, New York, NY, USA. 3. 3 Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA. 4. 4 Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA. 5. 5 Department of Human Development, Cornell University, Ithaca, NY USA.
Abstract
BACKGROUND: Over 10% of hospice patients experience a transition out of hospice care during the last months of life. Hospice transitions from home to hospital (ie, hospital-related hospice disenrollment) result in fragmented care, which can be burdensome for patients and caregivers. Nurses play a major role in delivering home hospice care, yet little is known about the association between nursing visits and disenrollment. OBJECTIVES: The study's purpose is to examine the association between the average number of nursing visits per week and hospital-related disenrollment in the home hospice population. We hypothesize that more nursing visits per week will be associated with reduced odds for disenrollment. DESIGN: A retrospective cohort study using Medicare data. PARTICIPANTS: Medicare hospice beneficiaries who were ≥18 years old in 2012. OUTCOME MEASURED: Hospitalization within 2 days of hospice disenrollment. RESULTS: The sample included 115 103 home hospice patients, 6450 (5.6%) of whom experienced a hospital-related disenrollment. The median number of nursing visits per week was 2 (interquartile range 1.3-3.2), with a mean of 2.5 (standard deviation ±1.6). There was a decreased likelihood of a hospital-related disenrollment when comparing enrollments that had <3 nursing visits per week on average to 3 to <4 visits (odds ratio [OR] 0.39; P value <.001), 4 to <5 visits (OR 0.29; P value <.001), and 5+ visits (OR 0.21; P value <.001). CONCLUSIONS: More nursing visits per week was associated with a decreased likelihood of a hospital-related hospice disenrollment. Further research is needed to understand what components of nursing care influence care transitions in the home hospice setting.
BACKGROUND: Over 10% of hospice patients experience a transition out of hospice care during the last months of life. Hospice transitions from home to hospital (ie, hospital-related hospice disenrollment) result in fragmented care, which can be burdensome for patients and caregivers. Nurses play a major role in delivering home hospice care, yet little is known about the association between nursing visits and disenrollment. OBJECTIVES: The study's purpose is to examine the association between the average number of nursing visits per week and hospital-related disenrollment in the home hospice population. We hypothesize that more nursing visits per week will be associated with reduced odds for disenrollment. DESIGN: A retrospective cohort study using Medicare data. PARTICIPANTS: Medicare hospice beneficiaries who were ≥18 years old in 2012. OUTCOME MEASURED: Hospitalization within 2 days of hospice disenrollment. RESULTS: The sample included 115 103 home hospice patients, 6450 (5.6%) of whom experienced a hospital-related disenrollment. The median number of nursing visits per week was 2 (interquartile range 1.3-3.2), with a mean of 2.5 (standard deviation ±1.6). There was a decreased likelihood of a hospital-related disenrollment when comparing enrollments that had <3 nursing visits per week on average to 3 to <4 visits (odds ratio [OR] 0.39; P value <.001), 4 to <5 visits (OR 0.29; P value <.001), and 5+ visits (OR 0.21; P value <.001). CONCLUSIONS: More nursing visits per week was associated with a decreased likelihood of a hospital-related hospice disenrollment. Further research is needed to understand what components of nursing care influence care transitions in the home hospice setting.
Entities:
Keywords:
continuous home care; disenrollment; hospice; hospitalization; inpatient hospice care; nursing care
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