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July 29, 2024 Story by: Editor
A recent study has highlighted disparities in hospice discharge rates and outcomes among Black and Latino patients. According to research published in the Journal of the American Medical Association (JAMA) Network Open, Black and Hispanic patients are more likely to experience shorter hospice stays and be discharged to a hospital setting compared to other groups. Additionally, these populations face higher rates of burdensome care transitions compared to white patients.
The findings shed light on the health inequities that impact access to quality end-of-life care, noted Elizabeth Luth, assistant professor at Rutgers University’s family medicine and community health department. The study was co-authored by researchers from Care Dimensions, VNS Health, Weill Cornell Medicine, and Emory University.
“Black and Hispanic individuals who are discharged alive are also at greater risk for poor outcomes once they leave hospice,” Luth told Hospice News in an email. “Specifically, Black individuals are more likely to have a ‘revolving door’ experience: They are discharged alive, hospitalized, and then readmitted to hospice.”
The study analyzed the health trajectories of over 115,000 Medicare fee-for-service patients who passed away between 2014 and 2019. It found that around 15% of patients leave hospice before death due to reasons such as unplanned hospitalizations or to seek curative treatment. Of those discharged, approximately one in seven were either hospitalized or readmitted to hospice within two days.
Patients with the highest rates of rehospitalization or death after discharge were identified as Black or Hispanic and had hospice stays of seven days or less.
“Some individuals, such as those from racial and ethnic minority groups or those with shorter hospice stays, are more vulnerable to poor outcomes, such as hospital death or rehospitalization after being discharged,” Luth explained.
The study also found that nearly half (42%) of patients discharged alive from hospice died within six months. These live discharges often led to fragmented health care, the researchers pointed out.
Luth emphasized that this data can help hospices refine their care strategies to break down barriers to access and improve care quality for underserved populations.
“We wanted to learn more about what happens to individuals who are discharged alive from hospice because live discharge is important to policy makers, payers, hospice agencies, nurses, social workers, and families,” Luth said. “Our study offers insight into what occurs post-discharge, giving hospices the opportunity to better approach care for vulnerable groups.”
Patients who received general inpatient (GIP) or respite care had lower odds of hospitalization and hospice readmission. Inpatient hospice services accounted for 6.2% of hospice spending, mainly due to restrictive eligibility and limited availability, according to the study.
The findings suggest that GIP and respite care may help reduce burdensome transitions and provide better support to patients with more complex care needs.
The researchers recommended the widespread implementation of systemic discharge planning to improve care transitions for Black and Hispanic populations.
“Live discharge is very important to the U.S. Centers for Medicare & Medicaid Services (CMS),” Luth said. “[Hospices] want to provide high-quality care for dying individuals and their families while meeting regulatory guidelines. It’s essential for hospice providers to understand that the negative impacts of live discharge are not equally distributed among all hospice patients.”
Luth further called for greater collaboration among health care providers to address the unmet needs of underserved populations.
She also noted that adjusting hospice reimbursement structures to discourage discharge could help reduce high-cost health care utilization and rehospitalization rates.
“Improving patient care and experiences post-discharge will require collaboration and coordination between hospices and various providers. Integrated health systems, such as Accountable Care Organizations (ACOs), which are responsible for population health, may play a key role,” Luth said. Source: Hospice News
