title: Why Do Home Hospice Patients Return to the Hospital? A Study of Hospice Provider Perspectives.
abstract: BACKGROUND
  Hospice provides an opportunity for patients to receive care at home at the end of life (EOL); however, approximately 25% of patients who disenroll from hospice are hospitalized. Hospitalization can lead to poor care transitions and result in unwarranted care and adverse patient outcomes. Research examining reasons for hospitalization in this patient population is limited.
  
  
  OBJECTIVE
  The objective was to understand the reasons for hospitalization among home hospice patients through the perspectives of hospice interdisciplinary team (IDT) members.
  
  
  METHODS
  This was a qualitative study using a grounded theory approach. Seven semistructured focus group were conducted to solicit reasons for hospitalization among home hospice patients. Participants consisted of 73 home hospice IDT members from a not-for-profit hospice agency in New York City. Focus group recordings were transcribed and analyzed using content analysis.
  
  
  RESULTS
  Eight major themes were identified: (1) not fully understanding hospice, (2) lack of clarity about disease prognosis, (3) desire to continue receiving care from nonhospice physicians and hospital, (4) caregiver burden, (5) distressing/difficult-to-manage signs and symptoms, (6) caregivers' reluctance to administer morphine, (7) 911's faster response time compared to hospice, and (8) families' difficulty accepting patients' mortality.
  
  
  CONCLUSIONS
  Reasons for hospitalization in home hospice patients are multifactorial and complex. Our study highlights barriers and challenges that patients, families, physicians, and hospices face around home hospice care and hospitalization. More research is needed to elucidate these issues and develop viable strategies to address them.
authors.affiliation: 1 Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College , New York, New York.
authors.forename: Veerawat
authors.initials: V
authors.lastname: Phongtankuel
authors.affiliation: 1 Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College , New York, New York.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Scherban
authors.affiliation: 1 Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College , New York, New York.
authors.forename: Manney C
authors.initials: MC
authors.lastname: Reid
authors.affiliation: 2 Visiting Nurse Service , New York, New York.
authors.forename: Amanda
authors.initials: A
authors.lastname: Finley
authors.affiliation: 2 Visiting Nurse Service , New York, New York.
authors.forename: Angela
authors.initials: A
authors.lastname: Martin
authors.affiliation: 2 Visiting Nurse Service , New York, New York.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Dennis
authors.affiliation: 1 Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College , New York, New York.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Adelman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006699:Home Care Services / Q000706:statistics & numerical data; D017051:Hospice Care / Q000523:psychology* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D010361:Patients / Q000523:psychology*; D036301:Qualitative Research; D013727:Terminal Care / Q000523:psychology* / Q000706:statistics & numerical data