Does Continuous Hospice Care Help Patients Remain at Home?

In the U. S., hospices sometimes provide high-intensity “continuous care” in patients' homes. However, little is known about the way that continuous care is used or what impact continuous care has on patient outcomes. To describe patients who receive continuous care and determine whether contin...

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Bibliographic Details
Published in:Journal of pain and symptom management Vol. 50; no. 3; pp. 297 - 304
Main Authors: Casarett, David, Harrold, Joan, Harris, Pamela S., Bender, Laura, Farrington, Sue, Smither, Eugenia, Ache, Kevin, Teno, Joan
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.09.2015
Subjects:
Aged
Anesthesia & Perioperative Care
Caregivers
Cohort Studies
Death
Electronic Health Records
end of life
Family
Female
Home Care Services - statistics & numerical data
hospice
Hospice Care - methods
Hospice Care - statistics & numerical data
Hospitalization - statistics & numerical data
Humans
Inpatients - statistics & numerical data
Male
nursing
Nursing Homes - statistics & numerical data
Pain Medicine
United States > US
end of life
Death
nursing
hospice
ISSN:0885-3924, 1873-6513
Online Access:Get full text
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Summary:In the U. S., hospices sometimes provide high-intensity “continuous care” in patients' homes. However, little is known about the way that continuous care is used or what impact continuous care has on patient outcomes. To describe patients who receive continuous care and determine whether continuous care reduces the likelihood that patients will die in an inpatient unit or hospital. Data from 147,137 patients admitted to 11 U.S. hospices between 2008 and 2012 were extracted from the electronic medical records. The hospices are part of a research-focused collaboration. The study used a propensity score-matched cohort design. A total of 99,687 (67.8%) patients were in a private home or nursing home on the day before death, and of these, 10,140 (10.2%) received continuous care on the day before death. A propensity score-matched sample (n = 24,658) included 8524 patients who received continuous care and 16,134 patients who received routine care on the day before death. Using the two matched groups, patients who received continuous care on the day before death were significantly less likely to die in an inpatient hospice setting (350/8524 vs. 2030/16,134; 4.1% vs. 12.6%) (odds ratio [OR] 0.29; 95% CI 0.27–0.34; P < 0.001). When patients were cared for by a spouse, the use of continuous care was associated with a larger decrease in inpatient deaths (OR 0.12; 95% CI 0.09–0.16; P < 0.001) compared with those patients cared for by other family members (OR 0.37; 95% CI 0.32–0.42; P < 0.001). It is possible that unmeasured covariates were not included in the propensity score match. Use of continuous care on the day before death is associated with a significant reduction in the use of inpatient care on the last day of life, particularly when patients are cared for by a spouse.
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ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2015.04.007