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Medline ® Abstract for Reference 19

of 'Hospice: Philosophy of care and appropriate utilization in the United States'

Outcomes and characteristics of patients discharged alive from hospice.
Kutner JS, Meyer SA, Beaty BL, Kassner CT, Nowels DE, Beehler C
J Am Geriatr Soc. 2004 Aug;52(8):1337-42.
OBJECTIVES: To describe outcomes and characteristics of patients discharged alive from hospice.
DESIGN: Prospective cohort study using a telephone survey.
SETTING: Hospices (n=18) participating in the Population-Based Palliative Care Research Network during the 1-year study period.
PARTICIPANTS: English-speaking adults (n=164) who were discharged alive from participating hospices during the 1-year study period.
MEASUREMENTS: Mortality within 6 months of hospice discharge.
RESULTS: Thirty-five percent (n=48) of the 139 patients with known outcomes died within 6 months of hospice discharge, 15 of whom (31%) died without hospice readmission. There were no significant associationsbetween sex (P=.77), length of hospice service (P=.99), diagnosis (P=.73), discharge disposition (P=.54), admission evidence of prognosis of less than 6 months to live (P=.22-.95), Karnofsky score at admission or change between admission and discharge (P=.39, P=.38, respectively), or duration of hospice care after stabilization (P=.83) and mortality within 6 months after hospice discharge. Age (P=.11), discharge Karnofsky score (P=.17), and reason for discharge being improved or stabilized condition (P=.13) trended toward statistical significance. The strongest predictor of mortality after hospice discharge was a report that the patient's condition had worsened (hazard ratio=10.2, 95% confidence interval 4.5-23.4).
CONCLUSION: One-third of patients who were discharged from hospice died within 6 months of hospice discharge, indicating ongoing eligibility for hospice care even under the strictest interpretation of hospice eligibility criteria. Patients who are discharged from hospice care should be evaluated frequently, especially within the first weeks to months after discharge, for changes in status, unmet needs, and potential hospice readmission.
Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver, Colorado 90262, USA. Jean.Kutner@uchsc.edu