A Rapid 5-Question Screen to Assess Palliative Needs Among Cancer Patients in the ED (S755)

Abstract

Background. Previous research suggests that visits in the last two days of life are associated with improved bereaved family member perceptions of quality of care. Research Objectives. Examine hospice facility variation in nursing and Medical Social Worker (MSW) visits in the last two days of life among Medicare hospice decedents during 2010. Methods. The variation in rate of visits was examined by state and for individual hospices. A multivariate logit model examined how organizational characteristics of a hospice and the site of service upon death were associated with differential rates of visits after controlling for a patient’s age, gender, race, hospice principal diagnosis, and the Elixhauser Comorbidity Index. Results. In 2010, there were 567,891 hospice decedents who died while using Routine Home Care. The overall rate of decedents with visits in the last two days of life was 84.2% with state variation from 74.4% (MN) to 96.8%(AK) and variation among hospice facilities from 76.8% (25th percentile) to 95.8% (75th percentile). Decedents residing in a nursing home (NH) were less likely to get a visit than other locations. (79.6% versus 86.2%, AOR 0.66 95% CI). Visit patterns did not differ between for profit and not for profit hospices. Older hospices had a higher rate of visits in the last two days of life (86.1% versus 79.9%, AOR 1.48 95% CI). Conclusions. Skilled visits by a nursing and/or MSW vary by region and hospice programs. Hospice patients residing in a NH are less likely to get visits in the last 48 hours of life. Implications for research, policy, or practice. Additional research should explore why this variation exists and if the current rate reflects an opportunity for improvement for hospice providers.