Risk Factors for Hospitalization of Home Hospice Enrollees Development and Validation of a Predictive Tool

Area of Science:

• Gerontology
• Palliative Care
• Health Services Research

Background:

• Over 10% of hospice patients experience care transitions, often leading to fragmented care.
• Hospitalization from hospice, particularly to hospitals, poses challenges for patients and families.
• Predictors of hospitalization in end-of-life care remain poorly understood.

Purpose of the Study:

• To develop and validate a predictive model for hospitalization.
• Utilize prehospice admission risk factors for prediction.
• Improve care transition management for hospice enrollees.

Main Methods:

• Retrospective cohort study utilizing Medicare fee-for-service claims data.
• Included patients aged 18+ enrolled in Medicare hospice in 2012.
• Defined outcome as hospitalization within 2 days of hospice discharge.

Main Results:

• A predictive model was developed using data from 61,947 hospice enrollments.
• Key predictors identified: younger age (18-55), black race, eastern region, non-cancer diagnosis, ≥4 chronic conditions, ≥2 prior hospice enrollments, and not-for-profit hospice enrollment.
• A risk score tool was created; a cutoff of 18 predicted hospitalization with 22% positive predictive value.

Conclusions:

• Hospitalization in home hospice patients is multifactorial.
• Younger patients, minority groups, and those with numerous chronic conditions face higher hospitalization risks.
• The developed predictive tool can guide future research and clinical interventions for at-risk hospice patients.