Hospice Composition Based on Diagnosis is Associated with Caregiver-Reported Quality Measures

Context: Given that the composition of hospice patients' terminal diagnoses has become increasingly diverse, understanding whether hospices provide quality care to patients, regardless of disease, is important. However, data comparing diagnosis and caregiver-reported outcomes remain scarce. Objectives: To analyze the association between the composition of patients' terminal diagnoses and caregiver-reported quality measures. Methods: Using cross-sectional, publicly available data from the Centers for Medicare & Medicare Services (CMS), we analyzed data collected from 2015-2019. We conducted general linear model analyses to identify associations between hospice characteristics/practices and caregiver-reported outcomes. Results: Of the 2810 hospices, those that cared for a greater percentage of dementia patients had fewer caregivers, on average, who rated hospice a 9 or 10 (where 0 = low, 10 = high; β = -.094; 95% CI = -.147, -.038), reported they always received help for pain and symptoms (β = -.106, CI = -.156, -.056), and reported definitely having received the training they needed (β = -.151, CI = -.207, -.095). Those caring for more stroke patients had fewer caregivers, on average, who rated hospice a 9 or 10 (β = -.184, CI = .252, -.115), reported they always received help for pain and symptoms (β = -.188, CI = -.251, -.126), reported definitely having received the training they needed (β = -.254, CI = -.324, -.184), and reported that the hospice offered the right amount of emotional/spiritual support (β = -.056, CI = -.093, -.019). Conclusion: Hospices that cared for a greater proportion of dementia and stroke patients had poorer scores on caregiver-reported quality measures. These findings support efforts to identify mechanisms underlying these differences and to design strategies to ensure optimal outcomes for hospice patients regardless of diagnosis.