title: Risk Factors for Hospitalization of Home Hospice Enrollees Development and Validation of a Predictive Tool.
abstract: BACKGROUND
  Over 10% of hospice patients experience at least 1 care transition 6 months prior to death. Transitions at the end of life, particularly from hospice to hospital, result in burdensome and fragmented care for patients and families. Little is known about factors that predict hospitalization in this population.
  
  
  OBJECTIVE
  To develop and validate a model predictive of hospitalization after enrollment into home hospice using prehospice admission risk factors.
  
  
  METHODS
  Retrospective cohort study using Medicare fee-for-service claims.
  
  
  METHODS
  Patients enrolled into the Medicare hospice benefit were ≥18 years old in 2012.
  
  
  METHODS
  Hospitalization within 2 days from a hospice discharge.
  
  
  RESULTS
  We developed a predictive model using 61 947 hospice enrollments, of which 3347 (5.4%) underwent a hospitalization. Seven variables were associated with hospitalization: age 18 to 55 years old (adjusted odds ratio [95% confidence interval]: 2.94 [2.41-3.59]), black race (2.13 [1.93-2.34]), east region (1.97 [1.73-2.24]), a noncancer diagnosis (1.32 [1.21-1.45]), 4 or more chronic conditions (8.11 [7.19-9.14]), 2 or more prior hospice enrollments (1.75 [1.35-2.26]), and enrollment in a not-for-profit hospice (2.01 [1.86-2.18]). A risk scoring tool ranging from 0 to 29 was developed, and a cutoff score of 18 identified hospitalized patients with a positive predictive value of 22%.
  
  
  CONCLUSIONS
  Reasons for hospitalization among home hospice patients are complex. Patients who are younger, belong to a minority group, and have a greater number of chronic conditions are at increased odds of hospitalization. Our newly developed predictive tool identifies patients at risk for hospitalization and can serve as a benchmark for future model development.
authors.affiliation: 1 Department of Medicine, Division of Geriatrics and Palliative Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Veerawat
authors.initials: V
authors.lastname: Phongtankuel
authors.affiliation: 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
authors.forename: P
authors.initials: P
authors.lastname: Johnson
authors.affiliation: 1 Department of Medicine, Division of Geriatrics and Palliative Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Reid
authors.affiliation: 1 Department of Medicine, Division of Geriatrics and Palliative Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Adelman
authors.affiliation: 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.|3 Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Grinspan
authors.affiliation: 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Unruh
authors.affiliation: 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.|3 Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.
authors.forename: E
authors.initials: E
authors.lastname: Abramson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D000071069:Multiple Chronic Conditions / Q000453:epidemiology; D016017:Odds Ratio; D012111:Residence Characteristics; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013727:Terminal Care; D014481:United States; D055815:Young Adult
keywords: end-of-life; health-care utilization; home hospice; hospice; hospitalization; palliative care; predictive modeling