Survival Variation and Predictors of Length of Stay in U.S. Hospice Patients: A Retrospective Cohort Study

Hospice provides comfort care to patients at end of life. Survival of patients in hospice shows considerable variation. Using a large national database of hospice patient data from 2015-6 we perform a descriptive analysis and examine this variation, and associated factors. In our secondary analysis of 472,196 patients enrolled into hospice, we found a median duration of survival of less than 4 weeks, although approximately ten percent of patients survive longer than 6 months, the duration that CMS sets as the maximum survival prognosis for admission to hospice. Among the 4 drug classes (analgesic, anxiolytic, anti-nausea and laxatives) recognized by CMS as appropriate for hospice patients only 4% of patients had no prescriptions in these classes. Analgesic use rose steadily across the hospice episode, particularly near death. The variation in survival among patients and the frequency of survival in excess of 6 months points to the need for more accurate predictive models and an opportunity to employ statistical analysis for hospice admission.