Nursing Home-Hospice Collaboration and End-of-Life Hospitalizations Among Dying Nursing Home Residents.
Shubing Cai, Susan C Miller, Pedro L Gozalo
PMID 29191764WHAT IT FOUND
Higher nursing home hospice volume was associated with fewer end-of-life hospitalizations.
However, having four or more different hospice providers was associated with a 1 percentage point increase in hospitalizations, suggesting too many providers may disrupt care coordination.
Key findings
01A one percentage point increase in the volume of hospice services in a nursing home was associated with a 0.15 percentage point decrease in the likelihood of end-of-life hospitalization.
02After accounting for hospice volume, increasing from one to four or more hospice providers in a nursing home was associated with a 1 percentage point increase in the likelihood of end-of-life hospitalizations.
03The association between having more providers and higher hospitalization risk was primarily seen in nursing homes with a relatively high volume of hospice services, not in those with very low volume.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The study could not directly observe whether nursing homes had exclusive contractual relationships with hospice providers, inferring this only from the number of providers used. It was unclear who initiated hospice referrals (e.g., the nursing home or the resident/family). The findings regarding the number of providers and hospitalizations may not apply to rural nursing homes due to lower power and fewer providers in those settings. Unobserved concurrent changes in nursing home practices could have confounded the relationship between hospice use and hospitalizations.
Declared interests
The study was supported by the National Institute on Aging (N.I.H., Extramural). No other conflicts of interest were reported in the provided text.
The easy way to misread this
Do not interpret the association between multiple hospice providers and increased hospitalizations as proof that limiting provider choice improves outcomes. This is an observational study showing correlation, not causation, and the effect was not seen in rural homes or low-volume settings.