Recently, the National Quality Forum (NQF) endorsed a set of preferred practices for palliative and hospice care quality and identified hospice services as a national priority area for healthcare quality improvement. The preferred practices, however, were primarily identified through expert opinion and there have been no national studies linking use of hospice preferred practices with patient outcomes and hospice costs. A critical barrier to continued progress in the field is building the evidence base for the NQF preferred practices, as this proposal seeks to do.
The Specific Aims of this longitudinal study are: 1) Determine the association between hospice preferred practices (e.g., 24-hour crisis management phone access, more frequent pain and symptom management practices) and hospital utilization by patients receiving hospice care, including intensive care unit and emergency department admissions, and hospital versus home death;2) Determine the association between hospice preferred practices (e.g., an ethics committee, interdisciplinary team meetings that include nurses, social workers, physicians and chaplains, more frequent pain and symptom management practices) and hospice disenrollment and hospice length of stay;and 3) Examine the impact of hospice preferred practices on hospice costs. Until now, such a study was not feasible because we lacked national data on the use of preferred practices by hospices;however, Dr. Carlson's recent work conducted through her National Institute of Nursing Research K99/R00 collected and examined data from the National Hospice Survey, which surveyed a national random sample of hospices (N=591, 84% response rate) regarding their use of patient-centered and family- centered NQF preferred practices.
The aims of this proposal will be accomplished by linking the National Hospice Survey data to Medicare claims data for patients newly enrolled by hospices following the survey completion date and to hospice costs reports. We will employ hierarchical generalized linear models to test the associations between hospice preferred practices and outcomes, accounting for patient, hospice, and county level covariates. The proposed project is innovative in using the first, detailed national data on the use of preferred practices by hospices and linking these data to patient outcomes and hospice costs. The multidisciplinary research team assembled by Dr. Carlson has the background and expertise to successfully complete this project. The contribution of this study will be significant because it will identify the specific hospice practies that most strongly relate to patient outcomes and hospice costs. Such information may guide national recommendations on best practices and will inform regulatory and professional interventions to monitor and promote higher quality, more cost effective care at the end of life in the hospice setting.
The proposed research is relevant to public health as it responds to an urgent need for robust empirical data that identify practices associated with patient and family experiences at the end of life in the hospice setting. Hospice is an interdisciplinary approach to caring for patients and families and is used by more than forty percent of decedents in the U.S. annually;yet hospice practices that influence patient outcomes and hospice costs are not well-known. This project aligns with the mission of the National Institute of Nursing Research by building the evidence base for hospice preferred practices that relate to outcomes such as hospital and hospice utilization at the end of life, which are known to be important aspects of quality of life for patients and families.
| Rizzuto, Jessica; Aldridge, Melissa D (2018) Racial Disparities in Hospice Outcomes: A Race or Hospice-Level Effect? J Am Geriatr Soc 66:407-413 |
| De Vleminck, Aline; Morrison, R Sean; Meier, Diane E et al. (2018) Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study. J Am Med Dir Assoc 19:633-638 |
| Aldridge, Melissa D; Epstein, Andrew J; Brody, Abraham A et al. (2018) Association between Hospice Spending on Patient Care and Rates of Hospitalization and Medicare Expenditures of Hospice Enrollees. J Palliat Med 21:55-61 |
| Aldridge, Melissa D; Bradley, Elizabeth H (2017) Epidemiology And Patterns Of Care At The End Of Life: Rising Complexity, Shifts In Care Patterns And Sites Of Death. Health Aff (Millwood) 36:1175-1183 |
| Wang, Shi-Yi; Aldridge, Melissa D; Gross, Cary P et al. (2017) End-of-Life Care Transition Patterns of Medicare Beneficiaries. J Am Geriatr Soc 65:1406-1413 |
| Wang, Shi-Yi; Aldridge, Melissa D; Gross, Cary P et al. (2016) End-of-Life Care Intensity and Hospice Use: A Regional-level Analysis. Med Care 54:672-8 |
| Wang, Shi-Yi; Aldridge, Melissa D; Gross, Cary P et al. (2016) Transitions Between Healthcare Settings of Hospice Enrollees at the End of Life. J Am Geriatr Soc 64:314-22 |
| Aldridge, Melissa D; Epstein, Andrew J; Brody, Abraham A et al. (2016) The Impact of Reported Hospice Preferred Practices on Hospital Utilization at the End of Life. Med Care 54:657-63 |
| Wang, Shi-Yi; Aldridge, Melissa D; Canavan, Maureen et al. (2016) Continuous Home Care Reduces Hospice Disenrollment and Hospitalization After Hospice Enrollment. J Pain Symptom Manage 52:813-821 |
| Ghesquiere, Angela R; Aldridge, Melissa D; Johnson-Hürzeler, Rosemary et al. (2015) Hospice Services for Complicated Grief and Depression: Results from a National Survey. J Am Geriatr Soc 63:2173-80 |
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