Characteristics of Hospice Programs With Problematic Live Discharges

Area of Science:

• Healthcare Management
• Palliative Care Research
• Health Services Research

Background:

• Limited understanding exists regarding variations in hospice live discharges based on provider tax status and chain affiliation.
• Investigating these variations is crucial for improving end-of-life care quality and patient transitions.

Purpose of the Study:

• To identify and characterize hospices exhibiting high rates of problematic live discharge patterns.
• To analyze how hospice providers' profit status and chain affiliation influence these problematic discharge patterns.

Main Methods:

• Defined three problematic live discharge patterns: burdensome transitions (discharge, hospitalization, readmission), early discharge (within 7 days), and prolonged stays (after 180 days).
• Utilized a multivariate logistic model to assess the association between discharge patterns and hospice characteristics (chain affiliation, profit status).
• Adjusted for facility-level factors including diagnoses, patient demographics (race, age), and geographic location.

Main Results:

• In 2010, 18.0% of 996,208 hospice discharges were live discharges.
• For-profit hospices without chain affiliation had higher rates of burdensome transitions (18.2%) compared to for-profit hospices in national chains (12.1%).
• Not-for-profit providers demonstrated the lowest rate of burdensome transitions (1.4%). Approximately 33.8% of for-profit providers exhibited at least one problematic discharge pattern, versus 9.0% of not-for-profit providers.

Conclusions:

• Problematic live discharge patterns are significantly more prevalent among for-profit hospice providers.
• Independent for-profit hospices, not part of a larger chain, are particularly associated with higher rates of these concerning discharge patterns.