by Jean S. Kutner, MD, MSPH
In the context of the current regulatory environment, patients may be discharged from hospice care if their condition stabilizes or improves over time and the certifying physician is unable to conscientiously recertify the 6-month prognosis. Little is known about the characteristics or outcomes of patients who are determined to no longer be eligible for hospice care. To help address these issues, PoPCRN has conducted analyses of the combined 1996 and 1998 National Home and Hospice Care data to characterize rates and predictors of live hospice discharge.
Of the 807,733 patients in the combined 1996 and 1998 NHHCS Discharge Patient file who met study inclusion criteria, 761,858 (94%) were deceased and 45,875 (6%) were discharged alive. Those who were discharged alive were more likely to be female, have received hospice care for more than 60 days and to have a non-cancer diagnosis, particularly advanced cardiopulmonary or neurologic disease. Mean age and total number of aids used did not significantly differ between patients who were discharged alive and those who were deceased. Length of service > 60 days, cardiopulmonary diagnosis, neurologic diagnosis, female gender, worse functional status, and living in an institutional setting were independently associated with live hospice discharge.
Given the demonstrated differences between these patients and those who died while receiving hospice care, these data provide further impetus for careful study of the appropriateness of current hospice eligibility criteria, the determinants of hospice discharge and, most importantly, the outcomes of patients who are discharged alive from hospice and the impact of hospice discharge on patients and their families. PoPCRN’s current discharge study, in which patients are being followed monthly for 6 months after hospice discharge, should contribute to our understanding of the outcomes of these patients. We expect to complete 6 month data collection for all study participants by the end of December, and to have preliminary results available in time for the Spring edition of “What’s Poppin?”.