title: Can hospices predict which patients will die within six months?
abstract: OBJECTIVE
  To determine whether it is possible to predict, at the time of hospice enrollment, which patients will die within 6 months.
  
  
  METHODS
  Electronic health record-based retrospective cohort study.
  
  
  METHODS
  Patients admitted to 10 hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness).
  
  
  METHODS
  Hospice patients.
  
  
  METHODS
  Mortality at 6 months following hospice admission.
  
  
  RESULTS
  Among 126,620 patients admitted to 10 hospices, 118,532 (93.6%) died within 6 months. In a multivariable logistic regression model, five characteristics were independent predictors of 6-month mortality. For instance, patients younger than 65 years were less likely to die within 6 months (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.45-0.91; p=0.014). Conversely, male patients were more likely to die within 6 months (OR 1.47; 95% CI 1.05-2.02; p=;0.036). After adjusting for other variables in this model, there were several subgroups with a low probability of 6-month probability (e.g., stroke and Palliative Performance Scale [PPS] score=50; adjusted probability of 6-month mortality=39.4%; 95% CI: 13.9%-72.5%). However, 95% confidence intervals of these 6-month mortality predictions extended above 50%.
  
  
  CONCLUSIONS
  Hospices might use several variables to identify patients with a relatively low risk for 6-month mortality and who therefore may become ineligible to continue hospice services if they fail to show significant disease progression.
authors.affiliation: 1 Kansas City Hospice and Palliative Care , Kansas City, Missouri.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Harris
authors.forename: Tapati
authors.initials: T
authors.lastname: Stalam
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Ache
authors.forename: Joan E
authors.initials: JE
authors.lastname: Harrold
authors.forename: Teresa
authors.initials: T
authors.lastname: Craig
authors.forename: Joan
authors.initials: J
authors.lastname: Teno
authors.forename: Eugenia
authors.initials: E
authors.lastname: Smither
authors.forename: Meredith
authors.initials: M
authors.lastname: Dougherty
authors.forename: David
authors.initials: D
authors.lastname: Casarett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006738:Hospices; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors