Burdensome Transition Among Patients Discharged Alive from Hospice

In 2020, 15% of Medicare hospice enrollees experienced live discharge. Live discharges occur when an individual leaves hospice care before death and can be caused by unplanned hospitalization, transferring hospice services, or ineligibility for hospice. This transition is often consequential for patients and caregivers as it can lead to burdensome care transitions across different settings and unnecessary aggressive treatment at the end of life.  

In a study in JAMA Network Open, Dr. Yongkang Zhang, assistant professor of population health sciences, and colleagues investigated the factors associated with burdensome transitions following hospice live discharge.  

Burdensome transition is defined as hospitalization within two days of hospice live discharge, followed by hospice readmission within two days of hospital discharge, or hospitalization within two days of hospice live discharge with in-hospital death. 

Of 115,072 Medicare fee-for-service beneficiaries from 2014 to 2019, 9% of individuals discharged alive from hospice were hospitalized and readmitted to hospice and 3% were hospitalized and died in the hospital. This outcome may be attributed to patient assessment problems before discharge, lack of systematic approaches to live discharge planning, or disincentives for hospices to provide certain types of care. Higher odds of burdensome transition occur among people who identify as Black, have shorter hospice stays, or receive care from a for-profit hospice. Researchers suggest that clinical practice and policy should center those at risk for burdensome transition after hospice live discharge, with the goal of tailoring discharge to individual patient needs. 

"Hospice can provide comprehensive support and services to patients and their families at the end of life,” explained Dr. Zhang. “The Centers for Medicare and Medicaid Services have also proposed new quality measures to monitor and improve hospice care and reduce hospice live discharges. Our study provides important evidence of how these systems can improve end-of-life care for populations at risk of burdensome transition." 



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