JACC: Heart Failure
Predictors of Hospice Enrollment for Patients With Advanced Heart Failure and Effects on Health Care Use
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Author + information
- Laura P. Gelfman, MD, MPHa,b,∗ (laura.gelfman{at}mssm.edu),
- Yolanda Barrón, MSc,
- Stanley Moore, BSd,
- Christopher M. Murtaugh, PhDc,
- Anuradha Lala, MDe,
- Melissa D. Aldridge, PhD, MBAa,b and
- Nathan E. Goldstein, MDa,b
- aBrookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- bGeriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York
- cCenter for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York
- dIndependent Contractor, Bonny Doon, California
- eDivisions of Cardiology and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Laura Gelfman, Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, New York 10029.
Graphical abstract
Abstract
Objectives This study sought to: 1) identify the predictors of hospice enrollment for patients with heart failure (HF); and 2) determine the impact of hospice enrollment on health care use.
Background Patients with HF rarely enroll in hospice. Little is known about how hospice affects this group’s health care use.
Methods Using a propensity score–matched sample of Medicare decedents with ≥2 HF discharges within 6 months, an Outcome and Assessment Information Set (OASIS) assessment, and subsequent death, we used Medicare administrative, claims, and patient assessment data to compare hospitalizations, intensive care unit stays, and emergency department visits for those beneficiaries who enrolled in hospice and those who did not.
Results The propensity score–matched sample included 3,067 beneficiaries in each group with a mean age of 82 years; 53% were female, and 15% were Black, Asian, or Hispanic. For objective 1, there were no differences in the characteristics, symptom burden, or functional status between groups that were associated with hospice enrollment. For objective 2, in the 6 months after the second HF discharge, the hospice group had significantly fewer emergency department visits (2.64 vs. 2.82; p = 0.04), hospital days (3.90 vs. 4.67; p < 0.001), and intensive care unit stays (1.25 vs. 1.51; p < 0.001); they were less likely to die in the hospital (3% vs. 56%; p < 0.001), and they had longer median survival (80 days vs. 71 days; log-rank test p = 0.004).
Conclusions Beneficiaries’ characteristics, including symptom burden and functional status, do not predict hospice enrollment. Those patients who enrolled in hospice used less health care, survived longer, and were less likely to die in the hospital. A tailored hospice model may be needed to increase enrollment and offer benefits to patients with HF.
Footnotes
Dr. Gelfman has received support from the National Institute on Aging (K23AG049930), The Mount Sinai Older Adults Independence Center (P30AG028741), and the National Palliative Care Research Center. The core dataset analyzed in this study was developed as part of a project supported by grant R01HS020257 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily reflect the official view of the Agency for Healthcare Research and Quality or the National Institute on Aging or the U.S. Department of Veterans Affairs. The dataset for the zip code crosswalk was obtained from The Dartmouth Atlas, which is funded by the Robert Wood Johnson Foundation and the Dartmouth Clinical and Translational Science Institute, under award number UL1TR001086 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 17, 2018.
- Revision received April 3, 2018.
- Accepted April 20, 2018.
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