Risk Factors For Hospitalization Of Home Hospice Enrollees: Development And Validation Of A Predictive Tool.
Loading...
No Access Until
Permanent Link(s)
Collections
Other Titles
Authors
Abstract
Background: Over 10% of hospice patients experience at least one care transition 6-months prior to death. Transitions at the End-of-Life (EoL), particularly from hospice to hospital, result in burdensome and fragmented care for patients and families. Little is known about factors that predict hospitalization in this population. Objectives: To develop and validate a model predictive of hospitalization after enrollment into home hospice using pre-hospice admission risk factors. Design: Retrospective cohort study using Medicare fee-for-service claims. Subjects: Patients enrolled into the Medicare Hospice Benefit >= 18 years old in 2012. Outcome Measured: Hospitalization within 2 days from a hospice discharge. Results: We developed a predictive model using 61,947 hospice enrollments, of which 3,347 (5.4%) underwent a hospitalization. Seven variables were associated with hospitalization: age 18-55 years old (adjusted odds ratio [95% confidence interval]; 2.94 [2.41-3.59]), Black race (2.13, [1.93-2.34]), East region (1.97, [1.73-2.24]), a non-cancer diagnosis (1.32, [1.21-1.45]), 4 or more chronic conditions (8.11, [7.19-9.14]), 2 or more prior hospice enrollments (1.75, [1.35-2.26]), and enrollment in a not-for-profit hospice (2.01, [1.86-2.18]). A risk scoring tool ranging from 0 to 29 was developed and a cutoff score of 18 identified hospitalized patients with a positive predictive value of 22%. Conclusions: Reasons for hospitalization among home hospice patients are complex. Patients who are younger, belong to a minority group, and have a greater number of chronic conditions are at increased odds of hospitalization. Our newly developed predictive tool identifies patients at risk for hospitalization and can serve as a benchmark for future model development.
Journal / Series
Volume & Issue
Description
Sponsorship
Date Issued
2017
Publisher
Keywords
disenrollment; end of life; hospice; hospitalization
Location
Effective Date
Expiration Date
Sector
Employer
Union
Union Local
NAICS
Number of Workers
Committee Chair
Committee Co-Chair
Committee Member
Degree Discipline
Clinical & Translational Investigation
Degree Name
Degree Level
Master of Science
Related Version
Related DOI
Related To
Related Part
Based on Related Item
Has Other Format(s)
Part of Related Item
Related To
Related Publication(s)
Link(s) to Related Publication(s)
References
Link(s) to Reference(s)
Previously Published As
Government Document
ISBN
ISMN
ISSN
Other Identifiers
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
Types
dissertation or thesis