title: Hospice eligibility in patients who died in a tertiary care center.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Freund
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Weckmann
authors.forename: David J
authors.initials: DJ
authors.lastname: Casarett
authors.forename: Kristi
authors.initials: K
authors.lastname: Swanson
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Brooks
authors.forename: Ann
authors.initials: A
authors.lastname: Broderick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004608:Eligibility Determination; D005260:Female; D006738:Hospices; D017052:Hospital Mortality; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D019452:Terminally Ill
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