title: A national study of live discharges from hospice.
abstract: BACKGROUND
  Live discharges from hospice can occur because patients decide to resume curative care, their condition improves, or hospices may inappropriately use live discharge to avoid costly hospitalizations.
  
  
  OBJECTIVE
  Describe the variation, outcomes, and organizational characteristics associated with live discharges.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Medicare fee-for-service hospice beneficiaries.
  
  
  METHODS
  Overall rate, timing, and health care transitions of live discharges.
  
  
  RESULTS
  In 2010, 182,172 of 1,003,958 (18.2%) hospice discharges were alive. Hospice rate of live discharges varied by hospice program with interquartile range of 9.5% to 26.4% and by geographic regions with the lowest rate in Connecticut (12.8%) and the highest in Mississippi (40.5%). Approximately 1 in 4 (n=43,889; 24.1%) beneficiaries discharged alive were hospitalized within 30 days. Nearly 8% (n=13,770) had a pattern of hospice discharge, hospitalization, and hospice readmission. These latter cases account for $126 million in Medicare reimbursement. Not-for-profit hospice programs had a lower rate of live discharges compared to for-profit programs (14.6% versus 22.4%; adjusted odds ratio [AOR] 0.84, 95% confidence interval [CI] 0.77-0.91). More mature hospice programs (over 21 years in operation) had lower rates of live discharge compared to programs in operation for 5 years or less (14.2% versus 26.7%; AOR 0.71, 95% CI 0.65-0.77). Small for-profits in operation 5 years or less had a higher live discharge rate than older, for-profit programs (31.5% versus 14.3%, p<0.001).
  
  
  CONCLUSIONS
  Approximately 1 in 5 hospice patients are discharged alive with variation by geographic regions and hospice programs. Not-for-profit hospices and older hospices have lower rates of live discharge.
authors.affiliation: 1 School of Public Health, Center for Gerontology and Healthcare Research, Brown University , Providence, Rhode Island.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Teno
authors.forename: Michael
authors.initials: M
authors.lastname: Plotzke
authors.forename: Pedro
authors.initials: P
authors.lastname: Gozalo
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States