title: From hospice to hospital: short-term follow-up study of hospice patient outcomes in a US acute care hospital surveillance system.
abstract: OBJECTIVE
  In the USA, there is little systematic evidence about the real-world trajectories of patient medical care after hospice enrolment. The objective of this study was to analyse predictors of the length of stay for hospice patients who were admitted to hospital in a retrospective analysis of the mandatorily reported hospital discharge data.
  
  
  METHODS
  All acute-care hospitals in Florida during 1 January 2010 to 30 June 2012.
  
  
  METHODS
  All patients with source of admission coded as 'hospice' (n=2674).
  
  
  METHODS
  The length of stay and discharge status: (1) died in hospital; (2) discharged back to hospice; (3) discharged to another healthcare facility; and (4) discharged home.
  
  
  RESULTS
  Patients were elderly (median age=81) with a high burden of disease. Almost half died (46%), while the majority of survivors were discharged to hospice (80% of survivors, 44% of total). A minority went to a healthcare facility (5.6%) or to home (5.2%). Only 9.2% received any procedure. Respiratory services were received by 29.4% and 16.8% were admitted to the intensive care unit. The median length of stay was 1 day for those who died. In an adjusted survival model, discharge to a healthcare facility resulted in a 74% longer hospital stay compared with discharge to hospice (event time ratio (ETR)=1.74, 95% CI 1.54 to 1.97 p<0.0001), with 61% longer hospital stays among patients discharged home (ETR=1.61, 95% CI 1.39 to 1.86 p<0.0001). Total financial charges for all patients exceeded $25 million; 10% of patients who appeared to exit hospice incurred 32% of the charges.
  
  
  CONCLUSIONS
  Our results raise significant questions about the ethics and pragmatics of end-of-life medical care, and the intentions and scope of hospices in the USA. Future studies should incorporate prospective linkage of subjective patient-centred data and objective healthcare encounter data.
authors: Division of Evidence-Based Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
authors: Elizabeth Barnett
authors: EB
authors: Pathak
authors: Division of Evidence-Based Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA Department of Philosophy, University of South Florida, Tampa, Florida, USA.
authors: Sarah
authors: S
authors: Wieten
authors: Division of Evidence-Based Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
authors: Benjamin
authors: B
authors: Djulbegovic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017051:Hospice Care; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D012189:Retrospective Studies; D014481:United States
keywords: Epidemiology; General Medicine (see Internal Medicine)