Comparison of Hospice Eligible (HE) Versus Hospice Ineligible (HI) Patients Admitted to a Medical Service: A Retrospective Study (706)

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1.Review Hospice Eligibity Criteria.2.Describe the percentage of medical service patients who are hospice eligible on admission.3.Describe the resource use and survival of patients who were HE and HI at the time of admission to the Medical Service of a VA Medical Center. Background. Referral criteria for palliative care consultations remain unclear. Research objectives. Examine what proportion of patients admitted to a medical service are hospice eligible (HE), and associated differences in resource use and survival. Methods. The electronic charts of 93 patients consecutively admitted to the medical service at a VA medical center in October 2004, were reviewed for HE, demographics, resource utilization, and survival. HE was determined by the National Hospice Palliative Care Organization guidelines. In 2004, palliative care consultation teams were being established. Results. Ninety-three charts were reviewed. Median age was 70 years (38–92); 44% patients were Caucasian, 6% White Hispanic, and 48% African American. Admissions by service were general medicine (37%), cardiology (31%), hematology/oncology (18%), and MICU (12%). Thirty-two patients (35%) were HE. HE patients had a greater median age (75 years vs 66 years; p < 0.005). Median length of stay was five days with no difference between HE and hospice ineligible (HI) patients; one outlier (385 days) was in the HE group. Other measures of resource utilization, such as ICU days, number of procedures, and radiology studies, did not differ between the two groups. There were nine deaths, with 5/27 (19%) rate in HE and 4/51 (8%) in the HI group. Median survival of the HE group was 381 days (2–2,195) and 2,030 days (2–2,160) for the HI group (p < 0.001). One year after admission, 16/32 (50%) of the HE group, and 15/59 (25%) of the HI group had died. Conclusion. At time of admission to a medical service, 35% of patients were HE. HE patients had an increased death rate and decreased survival. Current hospice criteria missed half of the patients who died within one year of admission. Implications for research, policy, or practice. Hospice criteria may identify candidates for palliative care on inpatient medical services. Further research is needed to develop case-finding criteria.