Hospice eligibility in patients who died in a tertiary care center

Authors

  • Katherine Freund BS,

    1. University of Iowa Carver College of Medicine, Iowa City, Iowa
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  • Michelle T. Weckmann MS, MD,

    Corresponding author
    1. Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
    2. Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
    • Department of Family Medicine, 01102 PFP, University of Iowa Carver College of Medicine, Iowa City, IA 52242-1000
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    • Tel.: 319-384-7000; Fax: 319-384-7822

  • David J. Casarett MD,

    1. Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Institute on Aging, Center for Bioethics, Philadelphia Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
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  • Kristi Swanson MS,

    1. Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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  • Mary Kay Brooks RN, MSN, CPHQ,

    1. Office of Clinical Quality, Safety, and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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  • Ann Broderick MS, MD

    1. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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  • Disclosure: Support for this research was provided by the University of Iowa Carver College of Medicine, Medical Student Summer Research Fellowship Program (NIH 2-T35-HL007485-31). None of the authors have any financial conflicts of interest to report.

Abstract

BACKGROUND:

Hospice is a service that patients, families, and physicians find beneficial, yet a majority of patients die without receiving hospice care. Little is known about how many hospitalized patients are hospice eligible at the time of hospitalization.

METHODS:

Retrospective chart review was used to examine all adult deaths (n = 688) at a tertiary care center during 2009. Charts were selected for full review if the death was nontraumatic and the patient had a hospital admission within 12 months of the terminal admission. The charts were examined for hospice eligibility based on medical criteria, evidence of a hospice discussion, and hospice enrollment.

RESULTS:

Two hundred nine patients had an admission in the year preceding the terminal admission and a nontraumatic death. Sixty percent were hospice eligible during the penultimate admission. Hospice discussions were documented in 14% of the hospice-eligible patients. Patients who were hospice eligible had more subspecialty consults on the penultimate admission compared to those not hospice eligible (P = 0.016), as well as more overall hospitalizations in the 12 months preceding their terminal admission (P = 0.0003), and fewer days between their penultimate admission and death (P = 0.001).

CONCLUSION:

The majority of terminally ill inpatients did not have a documented discussion of hospice with their care provider. Educating physicians to recognize the stepwise decline of most illnesses and hospice admission criteria will facilitate a more informed decision-making process for patients and their families. A consistent commitment to offer hospice earlier than the terminal admission would increase access to community or home-based care, potentially increasing quality of life. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.

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