title: Hospice characteristics and the disenrollment of patients with cancer.
abstract: OBJECTIVE
  To characterize the types of hospices with higher rates of patient disenrollment from the Medicare Hospice Benefit and the markets in which these hospices operate.
  
  
  METHODS
  Secondary analyses of Surveillance, Epidemiology and End Results-Medicare data. Analyses included patients who died of cancer from 1998 to 2002 and who used hospice (n=90,826).
  
  
  METHODS
  We used generalized estimating equations to estimate the association of patient disenrollment with hospice size, years since Medicare certification, ownership, staff mix, competition, urban/rural status, region, and fiscal intermediary. Other covariates included patient demographic and clinical characteristics.
  
  
  RESULTS
  Patients were more likely to disenroll from hospice if they were served by newer hospices (OR=1.14; 95 percent CI 1.03, 1.26), by smaller hospices (OR=1.11; 95 percent CI 1.02, 1.20), or by hospices in more competitive markets (OR=1.17; 95 percent CI 1.03, 1.35). There was an independent effect of the hospice's fiscal intermediary on disenrollment, particularly disenrollment after 6 months with hospice (Wald chi(2)=21.2, p=.007).
  
  
  CONCLUSIONS
  The reasons for higher disenrollment rates for newer hospices, for smaller hospices, and for hospices in highly competitive markets are likely complex; however, results suggest that there are organizational-level barriers to keeping patients with cancer enrolled with hospice. Variation across fiscal intermediaries may indicate that regulatory oversight, particularly of long-stay patients, influences hospice disenrollment.
authors: Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
authors: Melissa D A
authors: MD
authors: Carlson
authors: Jeph
authors: J
authors: Herrin
authors: Qingling
authors: Q
authors: Du
authors: Andrew J
authors: AJ
authors: Epstein
authors: Emily
authors: E
authors: Cherlin
authors: R Sean
authors: RS
authors: Morrison
authors: Elizabeth H
authors: EH
authors: Bradley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D009369:Neoplasms / Q000145:classification / Q000401:mortality; D010352:Patient Dropouts; D018426:SEER Program; D014481:United States