Hospice eligibility in patients who died in a tertiary care center

• Published in: Journal of hospital medicine 2012-03, Vol.7 (3), p.218-223
• Main Authors: Freund, Katherine, Weckmann, Michelle T., Casarett, David J., Swanson, Kristi, Brooks, Mary Kay, Broderick, Ann
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; communication; Eligibility Determination; Female; Hospices; Hospital Mortality; Humans; Iowa - epidemiology; Male; Medical Audit; Middle Aged; palliative care; patient education; Reproducibility of Results; Retrospective Studies; Terminally Ill
• ISSN: 1553-5592; 1553-5606
• DOI: 10.1002/jhm.975

BACKGROUND: Hospice is a service that patients, families, and physicians find beneficial, yet a majority of patients die without receiving hospice care. Little is known about how many hospitalized patients are hospice eligible at the time of hospitalization. METHODS: Retrospective chart review was used to examine all adult deaths (n = 688) at a tertiary care center during 2009. Charts were selected for full review if the death was nontraumatic and the patient had a hospital admission within 12 months of the terminal admission. The charts were examined for hospice eligibility based on medical criteria, evidence of a hospice discussion, and hospice enrollment. RESULTS: Two hundred nine patients had an admission in the year preceding the terminal admission and a nontraumatic death. Sixty percent were hospice eligible during the penultimate admission. Hospice discussions were documented in 14% of the hospice‐eligible patients. Patients who were hospice eligible had more subspecialty consults on the penultimate admission compared to those not hospice eligible (P = 0.016), as well as more overall hospitalizations in the 12 months preceding their terminal admission (P = 0.0003), and fewer days between their penultimate admission and death (P = 0.001). CONCLUSION: The majority of terminally ill inpatients did not have a documented discussion of hospice with their care provider. Educating physicians to recognize the stepwise decline of most illnesses and hospice admission criteria will facilitate a more informed decision‐making process for patients and their families. A consistent commitment to offer hospice earlier than the terminal admission would increase access to community or home‐based care, potentially increasing quality of life. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.