title: All hospice patients are not equal: development of a visit-based acuity index.
abstract: BACKGROUND
  Although hospices need to be able to anticipate patient acuity, there are currently no published models that predict the frequency of visits that a new hospice patient is likely to receive.
  
  
  OBJECTIVE
  To identify patient characteristics that are associated with the frequency of health care provider visits in the first 8 days of hospice care.
  
  
  METHODS
  An electronic health record (EHR)-based retrospective cohort study was conducted in seven hospice programs in the United States. Participants were 35,232 patients who were admitted between October 1, 2008 and May 31, 2011 and received hospice care at home on the day of enrollment. The main outcome measure was the average number of visits per day by nurses, social workers, chaplains, and home health aides in the first 8 days of home hospice care (day of admission plus up to 7 subsequent days).
  
  
  RESULTS
  In a mixed effects regression model, 14 independent predictors of visit frequency were identified. For instance, several demographic characteristics were associated with more frequent visits, as were lower Palliative Performance Scale (PPS) scores (<40: 1.78 visits/day, 95% confidence interval [CI] 1.74-1.82 versus 40-60: 1.65 visits/day, 95% CI 1.61-1.69 versus >60: 1.41 visits/day, 95% CI 1.36-1.47; p<0.001), the presence of pain (pain: 1.77 visits/day; 95% CI 1.72-1.82 versus no pain: 1.44 visits/day, 95% CI .39-1.59; p<0.001). Patients admitted to home hospice from a hospital also received more frequent visits compared with other patients (hospital: 1.73 visits/day, 95% CI 1.67-1.79 versus home: 1.42 visits/day, 95% CI 1.40-1.44; p<0.001).
  
  
  CONCLUSIONS
  An acuity index based on these variables could help hospices to better anticipate patient needs and staff workload, and could be used to guide strategic planning as hospices take part in accountable care organizations (ACOs).
authors: 1 Hospice and Community Care , Lancaster, Pennsylvania.
authors: Joan
authors: J
authors: Harrold
authors: Elena
authors: E
authors: Byhoff
authors: Pamela
authors: P
authors: Harris
authors: Robertina
authors: R
authors: Szolarova
authors: Laura
authors: L
authors: Bender
authors: Teresa
authors: T
authors: Craig
authors: David
authors: D
authors: Casarett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D057286:Electronic Health Records; D005260:Female; D006301:Health Services Needs and Demand; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014481:United States