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Characterizing care of hospice patients in the hospital setting.

BACKGROUND
One measure of quality hospice care is minimization of hospitalization. Few studies have explored reasons for hospitalization and characteristics of care received by hospice patients in the hospital.


OBJECTIVES
To characterize the experience of hospice patients in the hospital and determine factors associated with high intensiveness of care.


DESIGN
Retrospective review of patient medical records in the Mayo Hospice Program in 2007.


RESULTS
Of 263 hospice patients, 17% were hospitalized in 2007. Of those hospitalized, 42% percent died in the hospital. Average length of stay was 4 days. Almost half were admitted through the emergency department. Common reasons for admission included delirium, pain, and falls. Most patients (52%) received care of a moderate level of intensity, with 18% receiving the most intensive level of care. Receiving care of high intensity was associated with emergency department admission. Charges to patient accounts averaged over $9,000 per stay. Concordance of care in the hospital to preexisting patient goals was high, but could not be determined in 39% of cases due to lack of documentation of patient goals.


CONCLUSIONS
Hospitalization of hospice patients is costly to the health care system. Most care was of low or moderate intensiveness. Quality improvements focusing on concise communication of patient goals and prevention of pain, delirium, and falls have the potential for the greatest impact on reducing hospitalizations and minimizing care that is discordant with patient goals.