Frequency and Risk Factors for Live Discharge from Hospice
- Autores: David Russell, Eli L. Diamond, Bonnie Lauder, Ritchell R. Dignam, Dawn W. Dowding, Timothy R. Peng, Holly G. Prigerson, Kathryn H. Bowles
- Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 65, Nº. 8, 2017, págs. 1726-1732
- Idioma: inglés
- Enlaces
-
Resumen
Objectives To report frequencies and associated risk factors for 4 distinct causes of live discharge from hospice.
Design Retrospective cohort study using electronic medical records of hospice patients who received care from a large urban not-for-profit hospice agency in New York City during a 3-year period between 2013 and 2015 (n = 9,190).
Results Roughly one in five hospice patients were discharged alive (21%; n = 1911). Acute hospitalization was the most frequent reason for live discharge (42% of all live discharges; n = 802). Additional reasons included elective revocation to resume disease-directed treatments (18%; n = 343), disqualification (14%; n = 271), and service transfers or moves (26%; n = 495). Multinomial logistic regression analyses revealed that risk for acute hospitalization was higher among younger patients (age AOR = 0.98 [95% CI = 0.98–0.99] P < .01), racial/ethnic minorities (Hispanic AOR = 2.23 [CI = 1.82–2.73] P < .001; African American OR = 2.46 [CI = 2.00–3.03] P < .001; Asian/other OR = 1.63 [CI = 1.25–2.11] P < .001), and patients without advance directives (AOR = 1.41 [95% CI = 0.98–0.99] P < .001). Disqualification occurred much more frequently among patients with non-cancer diagnoses, including dementia (AOR = 13.14 [95% CI = 7.96–21.61] P < .001) and pulmonary disease (AOR = 11.68 [95% CI = 6.58–20.74] P < .001). Transfers and service moves were more common among Hispanics (AOR = 1.56 [95% CI = 1.45–2.34] P < .001), African Americans (AOR = 1.35 [95% CI = 1.03–1.79] P < .05), patients without a primary caregiver (AOR = 1.35 [95% CI = 1.09–1.67] P < .001), and those without advance directives (AOR = 1.30 [95% CI = 1.07–1.58] P < .01).
Conclusion Further research into factors that underlie live discharge events, especially acute hospitalization, is warranted given their cost and burden for patients/families. Hospices should develop strategies to address acute medical crises and thoroughly evaluate patients’ suitability, unmet needs, and knowledge about end-of-life issues at the time of hospice enrollment, especially for those with non-cancer diagnoses.
