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. 2017 Sep;55(9):848-855.
doi: 10.1097/MLR.0000000000000776.

Associations of Hospice Disenrollment and Hospitalization With Continuous Home Care Provision

Shi-Yi Wang  1 , Weixiong Dang, Melissa D Aldridge, Maureen Canavan, Emily Cherlin, Elizabeth Bradley
Affiliations

Associations of Hospice Disenrollment and Hospitalization With Continuous Home Care Provision

Shi-Yi Wang et al. Med Care. 2017 Sep.

Abstract

Objectives: To examine rates of hospice disenrollment and posthospice hospitalization among patients who are enrolled in hospices that provide continuous home care (CHC) (CHC hospices) compared with patients who are enrolled in hospices that do not offer CHC (non-CHC hospices).

Methods: We performed a retrospective cohort study among Medicare fee-for-service decedents between July and December 2011, who were 66 years and older and had used hospice in their last 6 months of life. We used propensity score matching to account for potential confounding characteristics of hospices. Generalized estimating equation models were applied to estimate between CHC hospices and non-CHC hospices the associations of hospice disenrollment/hospitalization, adjusted for patient characteristics. We also conducted subgroup analyses to examine how the association might have differed by hospice size, and by the percentage of enrollees who received CHC.

Results: After matching, we identified 936 pairs of CHC and non-CHC hospices, well balanced in terms of organizational characteristics. In fully adjusted models, compared with non-CHC hospices, CHC hospices had significantly lower disenrollment rates (adjusted rate ratio, 0.73; 95% confidence interval, 0.60-0.87), and lower hospitalization rates (adjusted rate ratio, 0.79; 95% confidence interval, 0.66-0.95). These associations were significantly more pronounced among larger hospices (those with >175 enrollees during study period), and among hospices in which at least 7.3% of enrollees used CHC.

Conclusions: CHC hospices had significantly lower rates of hospice disenrollment and posthospice hospitalization, suggesting CHC service available may enable higher quality of end-of-life care.

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Conflict of interest statement

Financial Disclosures: None of the coauthors have conflicts of interest.

Figures

Appendix Figure
Appendix Figure. Diagram of study population selection
CHC: Continuous home care; PSM: Propensity score matching
Figure 1
Figure 1. Adjusted Rate Ratios of Hospice Disenrollment and Post-Hospice Hospitalization, CHC Hospices vs. Non-CHC Hospices According to Hospice Size, Entire Cohort*
*Reference: non-CHC hospices; Hospices with fewer than 176 enrollees during study period (median number of enrollees in our sample) were classified as small hospices. CHC: Continuous home care
Figure 2
Figure 2. Adjusted Rate Ratios of Hospice Disenrollment and Post-Hospice Hospitalization, CHC Hospices vs. Non-CHC Hospices According to the Percentage of Enrollees Receiving CHC, Propensity Score Matched Sample*
*The percentage of enrollees receiving CHC were categorized into quintiles as: 1st quintile: less than 1.7%; 2nd quintile: 1.7–3.6%; 3rd quintile: 3.6–7.3%; 4th quintile: 7.3–20.8%; 5th quintile: 20.8% and above. CHC: Continuous home care
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