Author + information
- Received December 21, 2018
- Revision received January 20, 2019
- Accepted January 23, 2019
- Published online June 24, 2019.
- David Russell, PhDa,b,∗ (, )
- Dawon Baik, PhD, RNc,
- Lizeyka Jordan, MPHa,
- Frances Dooley, MSN, RNd,
- Scott L. Hummel, MD, MSe,
- Holly G. Prigerson, PhDf,
- Kathryn H. Bowles, PhD, RNb,g and
- Ruth Masterson Creber, PhD, MSc, RNh
- aDepartment of Sociology, Appalachian State University, Boone, North Carolina
- bCenter for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York
- cSchool of Nursing, Columbia University, New York, New York
- dHospice and Palliative Care, Visiting Nurse Service of New York, New York, New York
- eFrankel Cardiovascular Center, University of Michigan and Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
- fWeill Cornell Medicine Center for Research on End-of-Life Care, New York, New York
- gUniversity of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
- hDepartment of Healthcare Research & Policy, Division of Health Informatics, Weill Cornell Medical College, New York, New York
- ↵∗Address for correspondence:
Dr. David Russell, Department of Sociology, Appalachian State University, ASU Box 32115, Boone, North Carolina 28608-2115.
Objectives This study identified sociodemographic and clinical factors that predicted live discharge among home hospice patients with heart failure, and related these findings to perspectives among health care providers about challenges to caring for these patients.
Background Hospice patients with heart failure are frequently discharged from hospice before death (“live discharge”). However, little is known about the factors and circumstances associated with live discharge among patients with heart failure.
Methods Quantitative analyses of patient medical records (N = 1,498) and qualitative interviews were performed with health care providers (n = 19) at a not-for-profit hospice agency in New York City.
Results Thirty percent of home hospice patients with heart failure experienced a live discharge, most frequently due to 911 calls that led to acute hospitalization. The odds of acute hospitalization were higher for younger patients (age 18 to 74 years: adjusted odds ratio [AOR]: 2.10; 95% confidence interval [CI]: 1.34 to 3.28), African American (AOR: 2.06; 95% CI: 1.31 to 3.24) or Hispanic (AOR: 2.99; 95% CI: 1.99 to 4.50) patients, and higher functioning patients (Palliative Performance Scores of 50% to 70%; AOR: 5.68; 95% CI: 3.66 to 8.79). Qualitative interviews with health care providers highlighted the unique characteristics of heart failure (e.g., sudden changes in patients’ condition), the importance of patients’ understanding of hospice and their own prognosis, and the role of sociocultural and family context in precipitating and potentially preventing live discharge (e.g., absence of social supports in the home).
Conclusions Live discharge from hospice, especially due to acute hospitalization, is common with heart failure. Greater attention is needed for patients’ knowledge of and readiness for hospice care, especially among younger and diverse populations, and for factors related to the social and family context in which hospice care is provided.
This study was supported by the Eugenie and Joseph Doyle Research Partnership Fund and by the National Institute of Nursing Research of the National Institutes of Health under Award Number R00NR016275. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 21, 2018.
- Revision received January 20, 2019.
- Accepted January 23, 2019.
- 2019 American College of Cardiology Foundation
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