Health-Care Utilization After Hospice Enrollment in Patients With Heart Failure and Cancer

Area of Science:

• Health Services Research
• Palliative Care
• Gerontology

Background:

• Hospice enrollment aims to manage end-of-life care, but healthcare utilization patterns can vary significantly among patient populations.
• Understanding how diagnoses influence resource use within hospice is crucial for optimizing care delivery and patient outcomes.

Purpose of the Study:

• To investigate the association between diagnosis (heart failure vs. cancer) and healthcare utilization, specifically emergency service use and hospital discharge, among hospice enrollees.
• To assess the impact of propensity score matching on observed differences in utilization between heart failure and cancer patients in hospice.

Main Methods:

• Analysis of the 2007 National Home and Hospice Care Survey data.
• Logistic regression modeling was employed to compare emergency service use and discharge to hospital for hospice patients with heart failure (n=311) and cancer (n=946).
• Propensity score matching was utilized to control for confounding variables and re-evaluate utilization differences.

Main Results:

• Before matching, heart failure patients exhibited twice the odds of emergency service use and discharge to hospital compared to cancer patients (P < .001 and P = .02, respectively).
• Post-propensity score matching, the disparity in emergency service use was reduced (OR: 1.6, P = .05), and the difference in discharge to hospital was eliminated (OR: 1.32, P = .45).
• Key correlates of healthcare utilization included diagnosis, place of care, and the presence of advance directives.

Conclusions:

• Diagnosis plays a significant role in healthcare utilization patterns following hospice enrollment.
• While initial differences in utilization between heart failure and cancer patients were substantial, statistical adjustments suggest diagnosis-specific needs require focused attention.
• Improved advanced care planning and tailored interventions for conditions like heart failure are essential to optimize hospice care and reduce potentially avoidable healthcare utilization.