Hospice Use Patterns of Medicare Beneficiaries with Parkinson Disease and Dementia with Lewy Bodies

• Published in: Journal of pain and symptom management 2024-05, Vol.67 (5), p.e568-e569
• Main Authors: Bock, Meredith, Gan, Siqi, Aldridge, Melissa, Harrison, Krista L., Yaffe, Kristine, Smith, Alexander, Boscardin, John, Hunt, Lauren
• Format: Article
• Language: English
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2024.02.366

1. Understand the differences in hospice use patterns for people with Parkinson's disease or Lewy body dementia compared to Alzheimer's disease. 2. Understand the differences in hospice characteristics for agencies caring for people with Parkinson's disease or Lewy body dementia compared to those caring for people with Alzheimer's disease. We found significant differences in demographic features, hospice characteristics, and patterns of use between those with a primary diagnosis of PD or DLB compared to AD. Aggregating patients with dementia into a single group ignores variation within this important population. There are growing numbers of Medicare beneficiaries enrolled in hospice with neurodegenerative disorders. Prior research has shown that people with all-cause dementia have high rates of suboptimal hospice use; however, little is known about how characteristics and use patterns for Parkinson's disease (PD) and Dementia with Lewy bodies (DLB) compare Alzheimer's disease. Our aim was to understand patient characteristics, hospice characteristics, and patterns of use for beneficiaries with PD and DLB compared to AD. We conducted a retrospective cohort study using a 100% sample of national 2010-2020 Medicare data. Our analytic cohort included beneficiaries over age 65 enrolled in hospice. We identified primary diagnoses of PD, DLB, and AD by ICD codes. Of 11,299,796 Medicare beneficiaries in our cohort, there were 956,719 (8.5%) with a primary diagnosis of AD, 232,445 (2.1%) with PD, and 49,270 (0.4%) with DLB. Compared to beneficiaries with AD, those with PD or DLB were more likely to be younger, male, and White. Hospice agencies caring for beneficiaries with PD or DLB were more likely to be older and non-profit than those caring for people with AD. Mean (+/- SD) length of stay for beneficiaries was 113.1 (+/-183.6) for PD, 105.4 (+/-117) for DLB, and 114.6 (+/- 190) days for AD (p < 0.001). People with PD were more likely to revoke hospice (7.0% for PD vs. 5.4% for AD and 5.1% for DLB) whereas people with AD were more likely to be disqualified for extended prognosis (9.3% for AD vs. 7.8% for PD and 7.7% for LBD, p< 0.001). There are significant differences in patient demographic characteristics, hospice agency characteristics, and hospice use patterns between Medicare beneficiaries with AD, PD, or DLB enrolled in hospice. Aggregating patients with dementia into a single group ignores variation within this important population. Scientific Research Advo