142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

State Level Variation in Hospital Death Rates and Hospice Utilization

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 10:50 AM - 11:05 AM

Benjamin Kofoed , Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN
Sarah Milder, MPH , Arundel Street Consulting, Saint Paul, MN
Anna Schenck, PhD, MSPH , Public Health Leadership Program and North Carolina Institute for Public Health, UNC Gillings School of Global Public Health, Chapel Hill, NC

Although most Americans prefer to die at home, roughly one quarter of deaths among seniors occur in acute care hospitals. There is potential for improvement in patient satisfaction if hospice services are better incorporated into end-of-life (EOL) care.


Our objective was to describe EOL care by state and to highlight geographic variation in hospice enrollment and hospital death rates.


A subset of measures from America’s Health Rankings Senior Report (SAHR) was selected to reflect EOL care. The selected variables were the percent of decedents aged 65 and older who died in a hospital and the percent of decedents aged 65 and older who were enrolled in hospice care during the last 6 months of life. Data from 2003-2007 and 2010 were used.


Utah ranked first in both hospice utilization (63.0%) and hospital deaths (16.4%) in the 2014 edition. Alaska had the lowest hospice utilization rate (22.2%) and New York had the highest prevalence of hospital deaths among seniors (35.1%). Hospice utilization and hospital death rates were significantly related (r=-0.536, p<0.005) in the expected direction, such that states with more hospice utilization had a lower rate of hospital deaths.


Hospital death rates and hospice care enrollment varied widely by state. States doing well on one measure tended to perform well on the other, but there were significant exceptions to this trend. Policies, resources, patient values, and other correlates may drive variation in end-of-life clinical care.

Learning Areas:

Provision of health care to the public

Learning Objectives:
Describe variation in hospital death rates and hospice enrollment by state. Discuss the relationship between these measures and the potential drivers of variation.

Keyword(s): End-of-Life Care, Hospitals

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am currently pursuing a Masters Degree at the University of Minnesota School of Public Health, where I have received training in research methodology. Additionally, I work as an intern on the "America's Health Rankings" publication for Arundel Street Consulting. In that role, I have collected and analyzed the data presented in this abstract.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
United Health Foundation Population Health Independent Contractor (contracted research and clinical trials)

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.