“Caring with Heart” In Their Own Words: The Meaning of Caring for Seriously Ill Patients (S739)

Abstract

Objectives Understand the importance of hospice for patients with heart failure and their families. Identify the differences in patients with advanced heart failure who enroll in hospice and those who do not. Brainstorm specific solutions to increase hospice enrollment for patients with advanced heart failure. Original Research Background. Heart failure (HF) patients have high symptom burden, re-hospitalization rates, mortality rates, and Medicare costs. Although hospice use is increasing for individuals with serious illness, a minority of HF patients receives hospice and little is known about their referral to hospice. Research Objectives. To examine the symptom burden, functional status, and healthcare utilization associated with hospice use and the timing of hospice referral in a sample of Medicare beneficiaries with advanced HF. Methods. Using linked Medicare claims from 2009 and 2010, we sampled Medicare beneficiaries with at least one home health claim, two HF hospitalizations in a six-month period, and an OASIS health assessment by a home care clinician within 7 days of the second HF discharge (the index discharge). We conducted bivariate analyses to compare hospice and non-hospice enrollees. Results. A total of 22,893 persons were included in the sample. Following the index discharge, 16,145 beneficiaries (70.5%) were re-hospitalized in the study period, a mean of number of 2.12 re-hospitalizations for hospice enrollees, and 2.23 for nonhospice enrollees. Of the sample, 3,921 (13.3%) enrolled in hospice. The mean number of days from index discharge to hospice enrollment was 59 days (SD 56.5) and the average hospice length of stay was 49 days (SD 78). Of the hospice enrollees, 324 (1.4%) were completely dependent on toileting compared to 834 (3.6%) of non-hospice enrollees (p<0.001). Of the hospice enrollees, 1,906 (8.3%) were short of breath at rest or with minimal exertion compared to 7,117 (31.1%) of non-hospice enrollees (p<0.001). Of the hospice enrollees, 249 (1.1%) had pain all of the time compared to 1162 (5.1%) of nonhospice enrollees (p1⁄40.56). Conclusions. Advanced HF patients have severe symptoms, poor functional status, high utilization, and low hospice use. Implications for Research, Policy, or Practice. Further study is needed to identify ways to increase earlier hospice enrollment in this population. ‘‘Caring with Heart’’ In Their Own Words: The Meaning of Caring for Seriously Ill Patients (S739) Mary Gergis, PhD, School of Nursing, University of Maryland, Baltimore, MD.