SURVIVAL OF MEDICARE PATIENTS AFTER ENROLLMENT IN HOSPICE PROGRAMS

Background Each year more than 220,000 Medicare beneficiaries receive care from hospice programs designed to enhance the quality of the end of life. Enrollment requires certification by a physician that the pat ient has a life expectancy of less than six months. We examined how lo ng before death patients enrolled in hospice programs. Methods Using 1 990 Medicare claims data, we analyzed the characteristics and survival of 6451 hospice patients followed for a minimum of 27 months with res pect to mortality. Results The patients' mean age was 76.4 years; 92.4 percent were white, Half the patients were women, and 80.2 percent ha d cancer of some type. The most common diagnoses were lung cancer (21. 4 percent), colorectal cancer (10.5 percent), and prostate cancer (7.4 percent). The median survival after enrollment was only 36 days, and 15.6 percent of the patients died within 7 days. At the other extreme, 14.9 percent of the patients lived longer than six months. Survival v aried substantially according to diagnosis, even after adjustment for age and coexisting conditions. The unadjusted survival after enrollmen t was shortest for those with renal failure, those with leukemia or ly mphoma, and those with liver or biliary cancer; it was longest for tho se with chronic lung disease, those with dementia, and those with brea st cancer. Patients at for-profit, larger, outpatient, or newer hospic es lived longer after enrollment than those in other types of hospice programs. Conclusions Most patients who enter hospice care do so late in the course of their terminal illnesses, The timing of enrollment in hospice programs varies substantially with the characteristics of the patients and the hospices. (C) 1996, Massachusetts Medical Society.