Hospice Composition Based on Diagnosis is Associated with Caregiver-Reported Quality Measures.
Sulaiman Alshakhs, Elisabeth Sweet, Elizabeth Luth and 3 others
PMID 35442840WHAT IT FOUND
Hospices serving more patients with dementia or stroke received lower caregiver ratings for overall quality, pain and symptom help, training, and emotional support.
Cancer diagnoses showed no such association with most measures.
Key findings
01Hospices with a higher proportion of patients with dementia or stroke were associated with a lower percentage of caregivers who rated the hospice a 9 or 10.
02Higher proportions of patients with dementia, stroke, or other conditions were associated with lower caregiver reports of always receiving help for pain and symptoms.
03Hospices with a greater percentage of stroke patients had lower caregiver-reported quality measures across the outcomes examined.
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 hospice-level data, not patient-level data, so it cannot determine if individual caregivers of dementia or stroke patients rated care lower, only that agencies with more such patients had lower aggregate scores. The survey response rate was 32%, introducing potential bias if non-responding agencies differed from responders. The dataset did not include information on the care setting (e.g., home vs. nursing facility), which is known to influence quality perceptions and is often different for dementia and stroke patients. Patient ethnicity data were not available, which is a known confounder in access to high-quality palliative care. There is a temporal mismatch: patient composition data were from 2017, while caregiver ratings were from 2018-2019, meaning the caregivers surveyed did not necessarily care for the patients counted in the composition data.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that dementia or stroke causes lower quality care. This study shows an association at the agency level, not patient-level outcomes, and cannot separate the effects of diagnosis from other factors like care setting (home vs. facility) or patient ethnicity, which were not measured.