Hospice enrollment and hospitalization of dying nursing home patients

PURPOSE: This study's purpose was to evaluate whether Medicare hospice care provided in nursing homes is associated with lower hospitalization rates. SUBJECTS AND METHODS: This retrospective cohort study included nursing home residents in five states who enrolled in hospice between 1992 and 1996 (n = 9202), and who died before 1998. For each hospice patient, 3 nonhospice r esidents (2 in 106 instances) were chosen (n = 27,500). Medicare claims ide ntified hospice enrollment and acute care hospitalizations. RESULTS: Twenty-four percent of hospice and 44% of nonhospice residents wer e hospitalized in the last 30 days of life. Adjusting for confounders, hosp ice patients were less likely than nonhospice residents to be hospitalized (odds ratio 0.43; 95% confidence interval [Cl]: 0.39 to 0.46). Considering all of nonhospice residents who died (n = 226,469), those in facilities wit h no hospice had a 47% hospitalization rate, whereas rates were 41% in faci lities with low hospice use and 39% in facilities with moderate hospice use (5%+ of patients in hospice). Hospitalization was less likely for nonhospi ce residents in facilities with low hospice use (odds ratio 0.82; 95% Cl: 0 .80 to 0.84) and moderate hospice use (odds ratio 0.71; 95% Cl: 0.69 to 0.7 4), compared with those in facilities with no hospice. CONCLUSIONS: When integrated into the nursing home care processes, hospice care is associated with less hospitalization for Medicare hospice patients. Additionally, possibly through diffusion of palliative care philosophy and practices, nonhospice residents who died in nursing homes having a hospice presence had lower rates of end-of-tife hospitalizations. (C) 2001 by Exce rpta Medica, Inc.