title: Characteristics of Hospice Programs With Problematic Live Discharges.
abstract: BACKGROUND
  Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation.
  
  
  OBJECTIVE
  To characterize hospices with high rates of problematic patterns of live discharges.
  
  
  METHODS
  Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located.
  
  
  RESULTS
  In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers.
  
  
  CONCLUSIONS
  Problematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain.
authors.affiliation: Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA. Electronic address: Joan_Teno@brown.edu.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Teno
authors.affiliation: Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Bowman
authors.affiliation: Abt Associates, Cambridge, Massachusetts, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Plotzke
authors.affiliation: Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Gozalo
authors.affiliation: Abt Associates, Cambridge, Massachusetts, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Christian
authors.affiliation: Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Miller
authors.affiliation: Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Williams
authors.affiliation: Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000379:methods* / Q000706:statistics & numerical data*; D006738:Hospices / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States
keywords: Hospices; for-profit; hospice chain affiliation; live discharges; not-for-profit