The 130th Annual Meeting of APHA

Abstract #38961

Susan C. Miller, PhD, Center for Gerontology and Health Care Research and Department of Community Health, Brown University, 167 Angell Street, 3rd Floor, Providence, RI 02912, (401) 863-9216, Susan_Miller@brown.edu and Sherry Weitzen, MS, MHA, Community Health, Brown University, 171 Meeting Street, Providence, RI 02912.

Specific Purpose: This study's purpose was to determine if increased scrutiny of hospice claims initiated in 1995 may be associated with increases in short hospice stays.

Content: We studied hospice patients in nursing home (N=51,809) and non-nursing home (N=89,004) settings who were admitted between 1995 and March 2000 to hospices across seven states and under the ownership of one hospice provider.

Methodology: With data from the provider's centralized information system, we used ordinal logistic regression for analysis, stratified by nursing home versus non-nursing home sites of care, and clustered by the 21 individual hospice programs. Length of stay categories were <8 days, 8-14, 15-30, 31-90, 91-180 and >180 days.

Results: From 1995 to 2000, the median stay changed from 15 to 10 days in non-nursing home settings and from 26 to 12 in nursing homes. Compared to patients admitted in 1995, and controlling for patient diagnosis and sociodemographic factors, and for state, short stays significantly increased in each year after 1995 in nursing homes, and in years 1999 and 2000 in non-nursing home settings. In 1995, a nursing home resident admitted to hospice had a 25% probability of a <8 day stay and, in 2000, a 39% probability; a non-nursing home patient had a 33% probability in 1995 and a 40% probability in 2000.

Importance: Findings suggest that higher proportions of short hospice stays may be an unintended consequence of government review policies.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Describe how hospice lengths of stay have changed over time.
• Articulate the factors associated with short hospice lengths of stay.
• Discuss the potential causes of the observed independent association between a later year of hospice admission and shorter hospice lengths of stay.

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: For this study, I used data supplied by VITAS' Healthcare Corporation. The co-investigator and I were paid as independent consultants to conduct this study for VITAS.