Often, the transition to a different care setting is burdensome for the health of the patient

Black patients who leave hospice care and patients with short stays in hospice care are at increased risks for being admitted to a hospital after being discharged from hospice, according to Rutgers Health researchers.

Their study, published in JAMA Network Open, examined patient outcomes after hospice care discharges to determine what factors contribute to transitions that lead to negative health implications. 

“Hospice care teams may want to pay particular attention to the discharge planning needs of patients of racial and ethnic minority groups and patients with more complicated needs,” said Elizabeth Luth, the lead author of the study and a core faculty member of the Center for Healthy Aging Research at the Rutgers Institute for Health, Health Care Policy and Aging Research.

About 15 percent of patients leave hospice care before death for a number of reasons including unplanned hospitalization, seeking treatment for a terminal condition, transferring hospice services or condition stabilization. Often, the transition to a different care setting is burdensome for the health of the patient. According to researchers, the factors that contribute to the risk of burdensome transitions out of hospice care are understudied, but important for clinicians and policymakers to better understand. 

Using Medicare data from more than 115,000 patients from 2014-2019, researchers looked at different types of burdensome transitions out of hospice care, including patients admitted to a hospital after leaving care and patients who died while hospitalized. They sought to assess what individual patient, health care services and hospice organizational factors are associated with the different types of transition outcomes.

Researchers found that Black patients who had shorter hospice stays and received care from a for-profit hospice service had higher odds of a burdensome transition after they were discharged. About 42 percent of hospice patients who were discharged die within six months, “suggesting that uninterrupted hospice care may be appropriate for many individuals who were discharged,” the researchers found.

Inequitable access to health care services, as well as institutionalized racism, are important factors in racial and ethnic disparities in health outcomes, according to previous research published in The New England Journal of Medicine and The Lancet.

Researchers also found that inpatient respite (services providing short-term relief for family caregivers) and general inpatient care (short-term hospital care for symptom management) were associated with lower odds of hospitalization and hospice readmission.

“Policymakers may want to consider making inpatient respite and general inpatient care more widely available and accessible to families with members in hospice with complex needs to support better outcomes if they are discharged,” said Luth, who is an assistant professor in the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School.

Coauthors of the study include Caitlin Brennan and Susan Hurley of Care Dimensions, a hospice and palliative care facility in Massachusetts, Veerawat Phongtankuel, Holly Prigerson, and Yongkang Zhang of Weill Cornell Medicine, Miriam Ryvicker of VNS Health, a nonprofit, community-based health care organization in New York City, and Hui Shao of Emory University.