RPD122 - Healthcare Utilization Patterns and Outcomes Post-Hospice Live Discharge

Key Message : This NIH-funded study surveyed 58 patient-caregiver dyads in the year following a hospice live discharge. Results demonstrate low medical service utilization post-discharge, with caregivers relying instead on paid and unpaid support, some patients dying without hospice re-enrollment, and few patients accessing community palliative care.

Abstract: Background/Rational: Following a hospice live discharge, patients and their caregivers often need to re-establish or transition to other community services(1). Patients often continue to experience complex medical and psychosocial needs post-discharge(1,2), therefore, coordinated service utilization is critical to ensuring continuity of care(3).

Purpose: This NIH-funded study surveyed patient-caregiver dyads (n=58) following a hospice discharge due to extended prognosis, to better understand post-discharge service utilization, along with healthcare utilization outcomes (additional care transitions, hospice re-enrollment, and death).

Methods: Referred from US hospice agencies within one year of hospice discharge, patient-caregiver dyads completed 1 to 3 surveys via phone or video calls. Patient demographics and descriptive analysis of service utilization were calculated using proportions or mean (SD) where appropriate.

Results: The patient study sample was primarily female (72%) and Non-Hispanic White (74%), with half (50%) reporting an income under $25,000/year. Timing for data collection post-discharge varied (average of 208 days post-discharge) therefore data is limited to occurrences only through the time of final study participation. Eight patients (14%) died during the reporting period, though only 2 of these re-enrolled on hospice. Overall, 17% (n=10) reported re-enrolling in hospice post-discharge. 20% of patients experienced one or more additional healthcare transition following the discharge (e.g., hospitalization, transition to facility). The most reported post-discharge services were use of unpaid caregivers (43%), home health (34.5%), paid caregivers (32%), and specialty providers (31%). Only 13.8% (n=8) enrolled in community-based palliative care.

Conclusion: Results demonstrate that medical service utilization in the initial post-discharge period was relatively low, with caregivers relying instead on paid and unpaid support, some patients dying without hospice re-enrollment, and few patients accessing community palliative care. Additional related findings showed more than half of the sample experienced a negative transition off hospice(4) and reported poor care coordination at discharge(3), which may impact service utilization post-discharge.

References: 1. Wladkowski, S.P., & +Wallace, C.L. (2022). The Forgotten and Misdiagnosed Care Transition: Live Discharge from Hospice Care. Gerontology and Geriatric Medicine, 8 (January-December,2022). https://doi.org/10.1177/23337214221109984
2. Wladkowski, S.P., Wallace, C.L., *Coccia, K., Hyde, R.C., Hinyard, L., & +Washington, K.T. (2024). Live Discharge of Hospice Patients with Alzheimer’s Disease and Related Dementias: A Systematic Review. American Journal of Hospice & Palliative Medicine, 41(2), 228-239. https://doi.org/10.1177/10499091231168401
3. Wallace C, Wladkowski S, Juboori RA, Becker T, Trinitas J, Hinyard L, Hendricks-Ferguson V. The role of hospice care coordination in the experience of live discharge transitions. Innovation in Aging. 2024 Dec;8(Supplement_1):549-50. https://doi.org/10.1093/geroni/igae098.1796
4. Hinyard L, Wladkowski S, Hendricks-Ferguson V, Juboori RA, Coccia K, Bennett A, Wallace C. Utility of the Care Transition Measure (Ctm-15) and a Measure of Continuity of Care in Live Discharge. Innovation in Aging. 2024 Dec;8(Supplement_1):550-1. https://doi.org/10.1093/geroni/igae098.1799