Characteristics of Hospice Programs With Problematic Live Discharges

J Pain Symptom Manage. 2015 Oct;50(4):548-52. doi: 10.1016/j.jpainsymman.2015.05.001. Epub 2015 May 21.


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.

Keywords: Hospices; for-profit; hospice chain affiliation; live discharges; not-for-profit.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged, 80 and over
  • Female
  • Hospice Care / methods*
  • Hospice Care / statistics & numerical data*
  • Hospices / methods*
  • Hospices / statistics & numerical data*
  • Humans
  • Logistic Models
  • Male
  • Medicare
  • Multivariate Analysis
  • Patient Admission / statistics & numerical data
  • Patient Discharge / statistics & numerical data*
  • Time Factors
  • United States