Population-Based Study of Hospice, Parts 1-4

摘要

The purpose of the cooperative agreement was to study: health service utilization among hospice and nonhospice terminal cancer patients; effects of hospital prospective reimbursement on hospice case load and length of stay; the extent of hospice penetration of the market. The area under study comprises 13 counties in western Washington. During the last month of life, hospice patients in 3 of the 4 types of hospice (home health hospice patients, hospice-only hospice patients and community-based hospice patients) used fewer hospital and skilled nursing facility days than patients in the home health conventional care group. No consistently lower inpatient utilization for hospice patients was found in the other months of the last year of life. Three multivariate models showed greater home health utilization among the home health agency-based and community-based hospice patients than among other hospice and non-hospice patients. Use of hospice is more likely among those who are more economically advantaged and are more likely to have social support. Patients diagnosed close to death were less likely to use hospice than were those diagnosed earlier. Hospice participation was the major determinant of death at home.