title: The growth of hospice care in U.S. nursing homes.
abstract: OBJECTIVE
  To inform efforts aimed at reducing Medicare hospice expenditures by describing the longitudinal use of hospice care in nursing homes (NHs) and examining how hospice provider growth is associated with use.
  
  
  METHODS
  Longitudinal study using NH resident assessment (Minimum Data Set) and Medicare denominator and claims data for 1999 through 2006.
  
  
  METHODS
  NHs in the 50 U.S. states and the District of Columbia.
  
  
  METHODS
  Persons dying in U.S. NHs.
  
  
  METHODS
  Medicare beneficiaries dying in NHs, receipt of NH hospice, and lengths of hospice stay were identified. The number of hospices providing care in NHs was also identified, and a panel data fixed-effect (within) regression analysis was used to examine how growth in providers affected hospice use.
  
  
  RESULTS
  Between 1999 and 2006, the number of hospices providing care in NHs rose from 1,850 to 2,768, and rates of NH hospice use more than doubled (from 14% to 33%). With this growth came a doubling of mean lengths of stay (from 46 to 93 days) and a 14% increase in the proportion of NH hospice decedents with noncancer diagnoses (69% in 1999 to 83% in 2006). Controlling for time trends, for every 10 new hospice providers within a state, there was an average state increase of 0.58% (95% confidence interval=0.383-0.782) in NH hospice use. Much state variation in NH hospice use and growth was observed.
  
  
  CONCLUSIONS
  Policy efforts to curb Medicare hospice expenditures (driven in part by provider growth) must consider the potentially negative effect of changes on access for dying (mostly noncancer) NH residents.
authors.affiliation: Center for Gerontology and Healthcare Research, Alpert Medical School, Brown University, Providence, Rhode Island 02889, USA. Susan_Miller@brown.edu
authors.forename: Susan C
authors.initials: SC
authors.lastname: Miller
authors.forename: Julie
authors.initials: J
authors.lastname: Lima
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Gozalo
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D009735:Nursing Homes / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000706:statistics & numerical data; D014481:United States