Abstract T MP96: Trends and Variation in Inpatient Discharge to Hospice Among High Stroke Volume Hospitals

Abstract

Background: In recent years, individuals with acute ischemic stroke accounted for approximately 4% of all inpatients discharged to hospice, yet little is known about current practices and trends in discharge to hospice care for stroke admissions within US hospitals. Methods: We examined rates of hospice discharge for adult acute ischemic stroke patients admitted to acute care facilities in the top quartile of annual stroke volume between 2001 and 2010 in the Nationwide Inpatient Sample. These high volume hospitals account for nearly 75% of stroke admissions in the dataset. Only those with available information on hospice discharge were considered. Compound annual growth rate was used to examine changes in utilization over time. Hospice trends were evaluated using the Cochran-Armitage test. Results: Among 1,935 high volume hospitals there were 455,372 hospitalizations for acute ischemic stroke from 2001 to 2010, 12,036 (2.6%) of which were discharged to hospice (30% to home; 70% to medical facility). The absolute number of discharges to hospice care grew at 29% per year over the ten-year period (P Trend<0.001). Discharge rates to hospice care per 100 stroke admissions increased from an average of 0.5 (SD=1.3) in 2001 to 4.3 (SD=3.0) in 2010 (P Trend<0.001). Inter-hospital variation in rates of hospice discharge remained large from year to year, and ranged from zero to 15.6 per 100 stroke admissions (Median=3.8; Interquartile Range=3.7) in 2010. Conclusions: The average rate of discharge to hospice care for acute ischemic stroke inpatients admitted to high volume hospitals has grown substantially in the past decade; variation in this practice across these hospitals remains large.