Continuous home care reduces hospice disenrollment and hospitalization after hospice enrollment

Abstract Objectives To identify hospice and patient characteristics associated with the use of continuous home care (CHC), and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment. Methods Using 100% fee-for-service Medicare claims...

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Bibliographic Details
Published in:Journal of pain and symptom management 2016-12, Vol.52 (6), p.813-821
Main Authors: Wang, Shi-Yi, MD, PhD, Aldridge, Melissa D., PhD, Canavan, Maureen, PhD, Cherlin, Emily, PhD, Bradley, Elizabeth, PhD
Format: Article
Language:English
Subjects:
Anesthesia & Perioperative Care
Beneficiaries
Cancer
continuous home care
end-of-life care
Enrollments
Health care expenditures
Home health care
Hospice
Hospice care
hospice disenrollment
Hospices
Hospitalization
Medicare
Older people
Pain Medicine
Patient admissions
Private sector
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Summary:Abstract Objectives To identify hospice and patient characteristics associated with the use of continuous home care (CHC), and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment. Methods Using 100% fee-for-service Medicare claims data for beneficiaries aged 66 years or older who died between July and December 2011, we identified the percentage of hospice agencies in which patients used CHC in 2011 and determined hospice and patient characteristics associated with use of CHC. Using multivariable analyses, we examined the associations between CHC utilization and hospice disenrollment and hospitalization after hospice enrollment, adjusted for hospice and patient characteristics. Results Only 42.7% of hospices (1,533 out of 3,592 hospices studied) provided CHC to at least 1 patient during the study period. Patients enrolled with for-profit, larger, and urban located hospices were more likely to use CHC (P-values < 0.001). Within these 1,533 hospices, only 11.4% of patients used CHC. Patients who were white, had cancer, and had more comorbidities were more likely to use CHC. In multivariable models, compared with patients who did not use CHC, patients who used CHC were less likely to have hospice disenrollment (adjusted odds ratio [AOR]: 0.21, 95% confidence interval [CI]: 0.19-0.23) and less likely to be hospitalized after hospice enrollment (AOR: 0.37, 95% CI: 0.34-0.40). Conclusions Although a minority of patients uses CHC, such services may be protective against hospice disenrollment and hospitalization after hospice enrollment.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2016.05.031