title: Exploring the association of hospice care on patient experience and outcomes of care.
abstract: OBJECTIVE
  To examine the association of the use of hospice care on patient experience and outcomes of care. Promoting high-value, safe and effective care is an international healthcare imperative. However, the extent to which hospice care may improve the value of care is not well characterised.
  
  
  METHODS
  A secondary analysis of variations in care was conducted using the Dartmouth Atlas Report, matched to the American Hospital Association Annual Survey Database to abstract organisational characteristics for 236 US hospitals to examine the relationship between hospice usage and a number of variables that represent care value, including hospital care intensity index, hospital deaths, intensive care unit (ICU) deaths, patient satisfaction and a number of patient quality indicators. Structural equation modelling was used to demonstrate the effect of hospice use on patient experience, clinical and efficiency outcomes.
  
  
  RESULTS
  Hospice admissions in the last 6 months of life were correlated with a number of variables, including increases in patient satisfaction ratings (r=0.448, p=0.01) and better pain control (r=0.491, p=0.01), and reductions in hospital days (r=-0.517, p=0.01), fewer hospital deaths (r=-0.842, p=0.01) and fewer deaths occurring with an ICU admission during hospitalisation (r=-0.358, p=0.01). The structural equation model identified that use of hospice care was inversely related to hospital mortality (-0.885) and ICU mortality (-0.457).
  
  
  CONCLUSIONS
  The results of this investigation demonstrate that greater use of hospice care during the last 6 months of life is associated with improved patient experience, including satisfaction and pain control, as well as clinical outcomes of care, including decreased ICU and hospital mortality.
authors.affiliation: Rush University Medical Center and Rush University College of Nursing, Chicago, Illinois, USA.
authors.forename: Ruth
authors.identifier: http://orcid.org/0000-0003-0142-7527
authors.initials: R
authors.lastname: Kleinpell
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Veteran's Affairs, Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA.
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Vasilevskis
authors.affiliation: Rush University Medical Center and Rush University College of Nursing, Chicago, Illinois, USA.
authors.forename: Louis
authors.initials: L
authors.lastname: Fogg
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Veteran's Affairs, Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA.
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States
keywords: Clinical decisions; Hospital care; Methodological research