Summary by Cordt Kassner, PhD
In the spring of 2000, Connie Beehler, MD, then Medical Director at Porter Hospice / Hospice of Peace in Denver, Colorado (now Medical Director at the Hospice at Riverside and Grant, Columbus, OH) was having a discussion with Jean Kutner, MD, MSPH. The discussion focused on what happens to patients after they are discharged alive from hospice. Very little information addressed this topic in the literature, so with the help of Dr. Beehler, PoPCRN designed and implemented a study to learn more about hospice patients who are discharged alive.
PoPCRN sites participating in this study obtained patient consent for this study and completed a 1-page information survey at the time of patient discharge. Site or PoPCRN personnel then conducted monthly prospective, telephone surveys until death or 6-months following hospice discharge.
Eighteen PoPCRN sites enrolled 164 patients into this study between 6/01-5/02. Monthly follow-up data was collected between 7/01-12/02. Demographic characteristics of enrolled patients included: 67% female; diagnosis cancer=29%, heart/lung=22%, neurologic=27%, rapid decline=15%; 46% were discharged home, 39% were discharged to a nursing home. Mean patient age=76 years (range=1-101 years). Mean admission Karnofsky score=37 (range=10-100), mean discharge Karnofsky score=45 (range=20-100). Mean hospice length of stay=128 days (range=1-773 days). Reasons for hospice discharge included: improved or stabilized condition=79%, patient/family decision=12%, to pursue more aggressive treatment=7%, financial reasons=0%, and payment denied by fiscal intermediary=0%.
Follow-up outcomes 6 months after patient discharge from hospice (total n=164) found 56% (n=91) alive, 29% (n=48) deceased, 12% (n=20) lost to follow-up, and 3% (n=5) withdrew consent. For patients who died (n=48), death occurred a mean of 86 days following hospice discharge (range=4-189 days). Of those with follow-up information (n=144), 29% (n=42) were readmitted to hospice (mean=55 days, range=1-175 days). For patients readmitted to hospice (n=42) and who died following readmission (n=32), death occurred a mean of 37 days following hospice readmission (range=2-179). Location of death for patients who died (n=48) included: 33% nursing home or SNF, 25% home, 25% unknown, 15% inpatient hospice, and 2% hospital.
Overall study conclusions include:
Study analysis is currently ongoing. Please contact PoPCRN for additional information regarding this study. We appreciate the 18 sites that participated in this study.