title: Frequency and Risk Factors for Live Discharge from Hospice.
abstract: OBJECTIVE
  To report frequencies and associated risk factors for 4 distinct causes of live discharge from hospice.
  
  
  METHODS
  Retrospective cohort study using electronic medical records of hospice patients who received care from a large urban not-for-profit hospice agency in New York City during a 3-year period between 2013 and 2015 (n = 9,190).
  
  
  RESULTS
  Roughly one in five hospice patients were discharged alive (21%; n = 1911). Acute hospitalization was the most frequent reason for live discharge (42% of all live discharges; n = 802). Additional reasons included elective revocation to resume disease-directed treatments (18%; n = 343), disqualification (14%; n = 271), and service transfers or moves (26%; n = 495). Multinomial logistic regression analyses revealed that risk for acute hospitalization was higher among younger patients (age AOR = 0.98 [95% CI = 0.98-0.99] P < .01), racial/ethnic minorities (Hispanic AOR = 2.23 [CI = 1.82-2.73] P < .001; African American OR = 2.46 [CI = 2.00-3.03] P < .001; Asian/other OR = 1.63 [CI = 1.25-2.11] P < .001), and patients without advance directives (AOR = 1.41 [95% CI = 0.98-0.99] P < .001). Disqualification occurred much more frequently among patients with non-cancer diagnoses, including dementia (AOR = 13.14 [95% CI = 7.96-21.61] P < .001) and pulmonary disease (AOR = 11.68 [95% CI = 6.58-20.74] P < .001). Transfers and service moves were more common among Hispanics (AOR = 1.56 [95% CI = 1.45-2.34] P < .001), African Americans (AOR = 1.35 [95% CI = 1.03-1.79] P < .05), patients without a primary caregiver (AOR = 1.35 [95% CI = 1.09-1.67] P < .001), and those without advance directives (AOR = 1.30 [95% CI = 1.07-1.58] P < .01).
  
  
  CONCLUSIONS
  Further research into factors that underlie live discharge events, especially acute hospitalization, is warranted given their cost and burden for patients/families. Hospices should develop strategies to address acute medical crises and thoroughly evaluate patients' suitability, unmet needs, and knowledge about end-of-life issues at the time of hospice enrollment, especially for those with non-cancer diagnoses.
authors.affiliation: Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, New York.
authors.forename: David
authors.initials: D
authors.lastname: Russell
authors.affiliation: Department of Neurology, Memorial Sloan Kettering Cancer Center, New York City, New York.|Center for Research on End of Life Care, Weill Cornell Medicine, New York City, New York.
authors.forename: Eli L
authors.initials: EL
authors.lastname: Diamond
authors.affiliation: Visiting Nurse Service of New York Hospice and Palliative Care, New York City, New York.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Lauder
authors.affiliation: Visiting Nurse Service of New York Hospice and Palliative Care, New York City, New York.
authors.forename: Ritchell R
authors.initials: RR
authors.lastname: Dignam
authors.affiliation: Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, New York.|Columbia University School of Nursing, New York City, New York.
authors.forename: Dawn W
authors.initials: DW
authors.lastname: Dowding
authors.affiliation: Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, New York.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Peng
authors.affiliation: Center for Research on End of Life Care, Weill Cornell Medicine, New York City, New York.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
authors.affiliation: Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, New York.|University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Bowles
mesh_terms: D016223:Advance Directives; D000367:Age Factors; D000368:Aged; D003704:Dementia; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006738:Hospices / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008297:Male; D009519:New York City; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: discharged alive; end of life; hospice; hospice outcomes; live discharge