title: Ownership status and patterns of care in hospice: results from the National Home and Hospice Care Survey.
abstract: BACKGROUND
  The number of for-profit hospices increased nearly 4-fold over the past decade, more than 6 times the growth of nonprofit hospices. Despite this growth, the impact of ownership on hospice care is largely unknown. We sought to assess differences in the provision of services to patients of for-profit and nonprofit hospices.
  
  
  METHODS
  Using the 1998 National Home and Hospice Care Survey, we examined services used by patients (N = 2080) cared for by 422 hospices nationwide. We used multivariable ordered logistic and logistic regression to assess the effect of profit status on service use, adjusting for potentially confounding patient and organizational characteristics. We calculated point estimates adjusted for sampling weights and standard errors adjusted for the clustering of patients within hospices.
  
  
  RESULTS
  In ordered logistic models controlling for organizational and patient factors, patients of for-profit hospices received a significantly narrower range of services (adjusted odds ratio [OR], 0.45; 95% confidence interval [CI], 0.22-0.92) than patients of nonprofit hospices. This result is driven by patients of for-profit hospices receiving significantly fewer types of hospice services that federal regulations term "noncore" or more discretionary services (adjusted OR, 0.34; 95% CI, 0.15-0.75).
  
  
  CONCLUSIONS
  The pattern of care differs in for-profit and nonprofit hospices. As the industry develops a substantial for-profit presence, it is critical for clinicians and other healthcare professionals to be alert to the potential impact of profit status on the care their patients receive.
authors.affiliation: Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Melissa D A
authors.initials: MD
authors.lastname: Carlson
authors.forename: William T
authors.initials: WT
authors.lastname: Gallo
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D005260:Female; D006269:Health Facilities, Proprietary / Q000191:economics / Q000592:standards; D006297:Health Services Accessibility; D006302:Health Services Research; D006738:Hospices / Q000191:economics* / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D009939:Organizations, Nonprofit / Q000191:economics / Q000592:standards; D010067:Ownership / Q000191:economics*; D011787:Quality of Health Care / Q000191:economics / Q000592:standards; D014481:United States