Introduction: The quality of hospice care has become a significant concern in recent years, with an increasing focus on improving the performance of hospice organizations. A significant challenge for hospice organizations is to consistently deliver high-quality care to patients, despite the complex nature of end-of-life care and the various challenges that hospice providers face. The purpose of this study is to identify the organizational and community factors that contribute to the success of top-performing hospices.

Methods: This is a retrospective observational study of secondary data from Hospice Compare, Healthcare Cost Report Information System, Medicare Post-Acute Care & Hospice, and American Community Survey. The dependent binary variable showed consistently overperforming hospices on quality process measures in years 2016-2020 (n=350). The independent variables were hospice organizational and community factors. We used random-effects logistic regression, controlling for state and year fixed effects. The analytical sample had 5,520 unique hospices.

Results: Among organizational factors, chain-affiliated and for-profit hospices were less likely to be among the top performers. Within community factors, hospices operating in areas with lower competition and lower percentages of racial minorities were more likely to be top performers. Furthermore, hospices with longer operational time and higher patient experience scores had higher odds of being top performers.

Discussion: Overall, this study highlights the importance of organizational and community-level factors in achieving and maintaining high-quality hospice care. As more and more hospices are converting into for-profit status, there may need to be more oversight to maintain higher quality of care.