Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study.
Aline De Vleminck, R Sean Morrison, Diane E Meier and 1 others
PMID 29153752WHAT IT FOUND
After adjustment, hospice patients with primary dementia were not more likely to disenroll overall, but they stayed longer and were more likely to be discharged after stays over 165 days.
They were less likely to leave for an acute hospitalization or ED visit.
Key findings
01In 149,814 hospice enrollees, 7328 (4.9%) had a primary dementia diagnosis; their mean hospice stay was 112 days, compared with 74 days for patients without a primary dementia diagnosis.
02After adjustment, patients with primary dementia were not significantly different from other patients in overall hospice disenrollment, but they were less likely to disenroll with an acute hospitalization or ED visit (OR 0.78; 95% CI 0.66-0.94) and more likely to disenroll after a stay over 165 days (OR 1.25; 95% CI 1.08-1.46).
03Hospice characteristics were linked to acute-event disenrollment: patients served by for-profit hospices were more likely to be discharged with an acute hospitalization or ED visit (OR 2.15; 95% CI 1.79-2.59), while patients served by hospices caring for more than 30% nursing home patients were less likely to be discharged in this way (OR 0.51; 95% CI 0.41-0.71).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used Medicare claims from 2008-2010, so it may not reflect current hospice practice. It excluded patients younger than 66, managed care enrollees, and patients not eligible for Medicare Parts A and B, so it does not apply to all hospice users. Dementia status was identified from Medicare hospice claims codes, not clinical review. The data did not include reasons for hospice disenrollment or how disenrollment related to patient and family preferences. Because this was an observational cohort, it cannot show that dementia caused the observed discharge patterns. Only hospices that responded to the National Hospice Survey were included, and hospices not participating in Medicare were not represented.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not conclude that hospice discharge after a long stay means a patient with dementia is no longer terminal or no longer needs palliative care. The study did not record reasons for disenrollment, and the median time from hospice disenrollment to death was 154 days for patients with dementia.