title: The effect of hospice on hospitalizations of nursing home residents.
abstract: OBJECTIVE
  Hospice enrollment is known to reduce risk of hospitalizations for nursing home residents who use it. We examined whether residing in facilities with a higher hospice penetration: (1) reduces hospitalization risk for nonhospice residents; and (2) decreases hospice-enrolled residents' hospitalization risk relative to hospice-enrolled residents in facilities with a lower hospice penetration.
  
  
  METHODS
  Medicare Beneficiary File, Inpatient and Hospice Claims, Minimum Data Set Version 2.0, Provider of Services File, and Area Resource File. Retrospective analysis of long-stay nursing home residents who died during 2005-2007. Overall, 505,851 nonhospice (67.66%) and 241,790 hospice-enrolled (32.34%) residents in 14,030 facilities nationwide were included. We fit models predicting the probability of hospitalization conditional on hospice penetration and resident and facility characteristics. We used instrumental variable method to address the potential endogeneity between hospice penetration and hospitalization. Distance between each nursing home and the closest hospice was the instrumental variable.
  
  
  RESULTS
  In the last 30 days of life, 37.63% of nonhospice and 23.18% of hospice residents were hospitalized. Every 10% increase in hospice penetration leads to a reduction in hospitalization risk of 5.1% for nonhospice residents and 4.8% for hospice-enrolled residents.
  
  
  CONCLUSIONS
  Higher facility-level hospice penetration reduces hospitalization risk for both nonhospice and hospice-enrolled residents. The findings shed light on nursing home end-of-life care delivery, collaboration among providers, and cost benefit analysis of hospice care.
authors.affiliation: Aging, Disability and Long Term Care, Division of Health Services and Social Policy Research, RTI International, Waltham, MA. Electronic address: ntzheng@rti.org.
authors.forename: Nan Tracy
authors.initials: NT
authors.lastname: Zheng
authors.affiliation: Department of Medicine, Health Policy Research Institute, University of California, Irvine, CA.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
authors.affiliation: Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Bruce
authors.initials: B
authors.lastname: Friedman
authors.affiliation: Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Caprio
authors.affiliation: Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY; Center for Ethics, Humanities and Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006707:Homes for the Aged / Q000706:statistics & numerical data; D017051:Hospice Care / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
keywords: End-of-life care; hospice care; hospitalization; nursing homes