title: Association Between Nursing Visits and Hospital-Related Disenrollment in the Home Hospice Population.
abstract: BACKGROUND
  Over 10% of hospice patients experience a transition out of hospice care during the last months of life. Hospice transitions from home to hospital (ie, hospital-related hospice disenrollment) result in fragmented care, which can be burdensome for patients and caregivers. Nurses play a major role in delivering home hospice care, yet little is known about the association between nursing visits and disenrollment.
  
  
  OBJECTIVE
  The study's purpose is to examine the association between the average number of nursing visits per week and hospital-related disenrollment in the home hospice population. We hypothesize that more nursing visits per week will be associated with reduced odds for disenrollment.
  
  
  METHODS
  A retrospective cohort study using Medicare data.
  
  
  METHODS
  Medicare hospice beneficiaries who were ≥18 years old in 2012.
  
  
  METHODS
  Hospitalization within 2 days of hospice disenrollment.
  
  
  RESULTS
  The sample included 115 103 home hospice patients, 6450 (5.6%) of whom experienced a hospital-related disenrollment. The median number of nursing visits per week was 2 (interquartile range 1.3-3.2), with a mean of 2.5 (standard deviation ±1.6). There was a decreased likelihood of a hospital-related disenrollment when comparing enrollments that had <3 nursing visits per week on average to 3 to <4 visits (odds ratio [OR] 0.39; P value <.001), 4 to <5 visits (OR 0.29; P value <.001), and 5+ visits (OR 0.21; P value <.001).
  
  
  CONCLUSIONS
  More nursing visits per week was associated with a decreased likelihood of a hospital-related hospice disenrollment. Further research is needed to understand what components of nursing care influence care transitions in the home hospice setting.
authors.affiliation: 1 Department of Medicine, Weill Cornell Medicine, New York, NY, USA.|2 New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Veerawat
authors.initials: V
authors.lastname: Phongtankuel
authors.affiliation: 1 Department of Medicine, Weill Cornell Medicine, New York, NY, USA.|2 New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Adelman
authors.affiliation: 1 Department of Medicine, Weill Cornell Medicine, New York, NY, USA.|2 New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Trevino
authors.affiliation: 2 New York-Presbyterian Hospital, New York, NY, USA.|3 Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA.|4 Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Abramson
authors.affiliation: 3 Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Johnson
authors.affiliation: 3 Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA.
authors.forename: Clara
authors.initials: C
authors.lastname: Oromendia
authors.affiliation: 5 Department of Human Development, Cornell University, Ithaca, NY USA.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Henderson
authors.affiliation: 1 Department of Medicine, Weill Cornell Medicine, New York, NY, USA.|2 New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Reid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; 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; D064691:Nurses, Community Health / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
keywords: continuous home care; disenrollment; hospice; hospitalization; inpatient hospice care; nursing care