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Hospice eligibility in patients who died in a tertiary care center
Author(s) -
Freund Katherine,
Weckmann Michelle T.,
Casarett David J.,
Swanson Kristi,
Brooks Mary Kay,
Broderick Ann
Publication year - 2012
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.975
Subject(s) - medicine , subspecialty , hospice care , tertiary care , terminally ill , hospital admission , advance care planning , family medicine , end of life care , retrospective cohort study , emergency medicine , palliative care , pediatrics , nursing
BACKGROUND: Hospice is a service that patients, families, and physicians find beneficial, yet a majority of patients die without receiving hospice care. Little is known about how many hospitalized patients are hospice eligible at the time of hospitalization. METHODS: Retrospective chart review was used to examine all adult deaths (n = 688) at a tertiary care center during 2009. Charts were selected for full review if the death was nontraumatic and the patient had a hospital admission within 12 months of the terminal admission. The charts were examined for hospice eligibility based on medical criteria, evidence of a hospice discussion, and hospice enrollment. RESULTS: Two hundred nine patients had an admission in the year preceding the terminal admission and a nontraumatic death. Sixty percent were hospice eligible during the penultimate admission. Hospice discussions were documented in 14% of the hospice‐eligible patients. Patients who were hospice eligible had more subspecialty consults on the penultimate admission compared to those not hospice eligible ( P = 0.016), as well as more overall hospitalizations in the 12 months preceding their terminal admission ( P = 0.0003), and fewer days between their penultimate admission and death ( P = 0.001). CONCLUSION: The majority of terminally ill inpatients did not have a documented discussion of hospice with their care provider. Educating physicians to recognize the stepwise decline of most illnesses and hospice admission criteria will facilitate a more informed decision‐making process for patients and their families. A consistent commitment to offer hospice earlier than the terminal admission would increase access to community or home‐based care, potentially increasing quality of life. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine.