title: Continuous Home Care Reduces Hospice Disenrollment and Hospitalization After Hospice Enrollment.
abstract: Among the four levels of hospice care, continuous home care (CHC) is the most expensive care, and infrequently provided in practice.
  
  
  
  To identify hospice and patient characteristics associated with the use of CHC and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment.
  
  
  
  Using 100% fee-for-service Medicare claims data for beneficiaries aged 66 years or older who died between July and December 2011, we identified the percentage of hospice agencies in which patients used CHC in 2011 and determined hospice and patient characteristics associated with the use of CHC. Using multivariable analyses, we examined the associations between CHC utilization and hospice disenrollment and hospitalization after hospice enrollment, adjusted for hospice and patient characteristics.
  
  
  
  Only 42.7% of hospices (1533 of 3592 hospices studied) provided CHC to at least one patient during the study period. Patients enrolled with for-profit, larger, and urban located hospices were more likely to use CHC (P < 0.001). Within these 1533 hospices, only 11.4% of patients used CHC. Patients who were white, had cancer, and had more comorbidities were more likely to use CHC. In multivariable models, compared with patients who did not use CHC, patients who used CHC were less likely to have hospice disenrollment (adjusted odds ratio 0.21; 95% CI 0.19, 0.23) and less likely to be hospitalized after hospice enrollment (adjusted odds ratio 0.37; 95% CI 0.34, 0.40).
  
  
  
  Although a minority of patients uses CHC, such services may be protective against hospice disenrollment and hospitalization after hospice enrollment.
authors.affiliation: Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut, USA. Electronic address: shiyi.wang@yale.edu.
authors.forename: Shi-Yi
authors.initials: SY
authors.lastname: Wang
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; James J. Peters VA Medical Center, Bronx, New York, USA.
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Aldridge
authors.affiliation: Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Canavan
authors.affiliation: Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Cherlin
authors.affiliation: Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005006:Ethnicity; D005260:Female; D006699:Home Care Services; D017051:Hospice Care; D006738:Hospices; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013727:Terminal Care; D014481:United States
keywords: Hospice; continuous home care; end-of-life care; hospice disenrollment