In the spring of 2000, Connie Beehler, MD, then Medical Director at Porter Hospice / Hospice of Peace in Denver, Colorado (now Medical Director at the Hospice at Riverside and Grant, Columbus, OH) was having a discussion with Jean Kutner, MD, MSPH. The discussion focused on what happens to patients after they are discharged alive from hospice. Very little information addressed this topic in the literature, so with the help of Dr. Beehler, PoPCRN designed and implemented a study to learn more about hospice patients who are discharged alive.
The citation for this abstract: Kutner JS, Meyer SA, Beaty B, Kassner CT, Nowels D, Beehler C. Outcomes and Characteristics of Patients Discharged Alive From Hospice. Journal of the American Geriatrics Society. In press, 2003.
ABSTRACT FOR “DISCHARGE FOLLOW-UP STUDY”
OBJECTIVES: To describe outcomes and characteristics of patients discharged alive from hospice.
DESIGN: Prospective cohort study using a telephone survey.
SETTING: Hospices (n= 18) participating in the Population-based Palliative Care Research Network (PoPCRN) during the 1-year study period.
PARTICIPANTS: English-speaking adults (n=164) who were discharged alive from participating hospices during the 1-year study period.
MEASUREMENTS: Mortality within 6 months of hospice discharge.
RESULTS: Thirty-five percent (n = 48) of the 139 patients with known outcomes died within six months of hospice discharge, 15 of whom (31%) died without hospice readmission. There were no significant associations between gender (P = .77), length of hospice service (P = .99), diagnosis (P = .73), discharge disposition (P = .54), admission evidence of prognosis < 6 months (P = .22 – .95), Karnofsky score at admission or change between admission and discharge (P = .39, P = .38 respectively) or duration of hospice care following stabilization (P = .83) and mortality within 6 months following hospice discharge. Age (P = .11), discharge Karnofsky score (P = .17), and reason for discharge being improved or stabilized condition (P = .13) trended towards statistical significance. The strongest predictor of mortality following hospice discharge was a report that the patient’s condition had worsened (hazard ratio 10.2, confidence limit 4.5 - 23.4).
CONCLUSION: One-third of patients who were discharged from hospice died within 6 months of hospice discharge, indicating ongoing eligibility for hospice care even under the strictest interpretation of hospice eligibility criteria. Patients who are discharged from hospice care should be evaluated frequently, especially within the first weeks to months following discharge, for changes in status, unmet needs and potential hospice readmission.
Please contact PoPCRN for additional information regarding this study. We appreciate the 18 sites that participated in this study.
The Discharge Follow-up Study Form (.pdf) is available via this link.