Outcomes and characteristics of patients discharged alive from hospice.
OBJECTIVE
To describe outcomes and characteristics of patients discharged alive from hospice.


METHODS
Prospective cohort study using a telephone survey.


METHODS
Hospices (n=18) participating in the Population-Based Palliative Care Research Network during the 1-year study period.


METHODS
English-speaking adults (n=164) who were discharged alive from participating hospices during the 1-year study period.


METHODS
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 associations between 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).


CONCLUSIONS
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
Jean S
JS
Kutner
Sue A
SA
Meyer
Brenda L
BL
Beaty
Cordt T
CT
Kassner
David E
DE
Nowels
Connie
C
Beehler
D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006738:Hospices; D006801:Humans; D017567:Karnofsky Performance Status; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009026:Mortality; D009820:Ohio; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies