257771 Evaluating Hospice Effect on Hospitalizations of Nursing Home Residents

Monday, October 29, 2012 : 2:30 PM - 2:42 PM

Nan Tracy Zheng, PhD , Aging, Disability and Long Term Care, RTI International, Waltham, MA
Dana B. Mukamel, PhD , Department of Medicine, Health Policy Research Institute, University of California, Irvine, Irvine, CA
Thomas V. Caprio, MD , Department of Medicine, University of Rochester, Rochester, NY
Bruce Friedman, PhD, MPH , Department of Community and Preventive Medicine, University of Rochester, Rochester, NY
Helena Temkin-Greener, PhD , Department of Community and Preventive Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
Study Objectives

US nursing home residents are frequently hospitalized at the end-of-life. Medicare pays about $1.6 billion annually for these end-of-life hospitalizations. Hospice enrollment has been shown to reduce nursing home residents' risk of hospitalization. We examined whether residing in facilities with higher hospice concentration can 1) reduce the risk of hospitalization in residents not receiving hospice (a spill-over effect); and 2) further decrease hospice residents' risk of hospitalization (an incremental effect).

Data Sources

Medicare Denominator File, Inpatient Claims and Hospice Claims were linked with the Minimum Data Set. Provider of Services File and Area Resource File were also used.

Study Design

We conducted cross-sectional analysis of secondary data. We used a national sample of 747,641 long-term-care residents (505,851 non-hospice and 241,790 hospice) in 14,030 nursing homes who died in 2005-2007.


We applied instrumental variable models to address the potential endogeneity between hospice concentration and hospitalization. The distance between each nursing home and the closest hospice was the instrumental variable.

Principal Findings

In the last 30 days of life, 37.6% of non-hospice and 23.2% of hospice residents were hospitalized. For every 10% increase in hospice concentration, non-hospice residents' risk of hospitalization decreased by 5.1%; hospice residents' risk of hospitalization decreased by 4.8%.


Increasing hospice concentration at the facility level reduces hospitalizations of non-hospice residents (spill-over effect) and further diminishes hospice residents' risk of hospitalization (incremental effect). Future evaluation of hospice effect on government expenditures should take into account these additional effects of hospice use.

Learning Areas:
Public health or related research

Learning Objectives:
Evaluate the effect of facility-level hospice concentration in a nurisng home on hospitalizations of its residents (both hospice and non-hospice users)

Keywords: End-of-Life Care, Nursing Homes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have five years of research experiences in nurisng home care and have recieved national recognition including publications in peer-reviewed journals and several national awards.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3303.0: End of Life Care Issues