Appendix Table 2.
Relationship between Local Hospice Utilization and 30-Day Rehospitalization, Adjusted for Patient Characteristics, Medical History, and Index Hospital Characteristics (N=1,725,043)
| Characteristic | Adjusted HR (95% CI) | P-value |
|---|---|---|
| Local hospice utilizationa | ||
| High | 1 (Reference) | |
| Medium | 1.01 (1, 1.02) | 0.0040 |
| Low | 1.05 (1.04, 1.06) | <0.0001 |
| Patient sociodemographic characteristics | ||
| Age, mean (SD) | ||
| 65–69 years | 1 (Reference) | |
| 70–74 years | 1 (0.98, 1.02) | 0.87 |
| 75–79 years | 1.01 (0.99, 1.02) | 0.38 |
| 80–84 years | 1.02 (1.01, 1.04) | 0.003 |
| ≥85 years | 1.03 (1.01, 1.04) | 0.001 |
| Gender | ||
| Male | 1 (Reference) | |
| Female | 0.93 (0.92, 0.94) | <0.0001 |
| Race | ||
| White | 1 (Reference) | |
| Black | 1.07 (1.05, 1.09) | <0.0001 |
| Other | 0.99 (0.97, 1.01) | 0.40 |
| Medicaid enrollment | 1 (0.99, 1.01) | 0.91 |
| Percentage of adults age ≥25 with at least a high school diploma in patient's census block groupb | 0.85 (0.82, 0.89) | <0.0001 |
| Percentage below poverty level in patient's census block groupb | 1 (0.95, 1.06) | 0.930 |
| Patient medical history | ||
| Community HCC score prior to hospitalization, mean (SD) | ||
| 1st quartile (mean=0.75) | 1 (Reference) | |
| 2nd quartile (mean=1.56) | 1.3 (1.28, 1.32) | <0.0001 |
| 3rd quartile (mean=2.67) | 1.57 (1.55, 1.59) | <0.0001 |
| 4th quartile (mean=5.15) | 1.92 (1.89, 1.95) | <0.0001 |
| Elixhauser comorbidities | ||
| Hypertension | 0.92 (0.91, 0.93) | <0.0001 |
| Fluid and electrolyte disorders | 1.14 (1.13, 1.15) | <0.0001 |
| Chronic pulmonary disease | 1.1 (1.09, 1.11) | <0.0001 |
| Congestive heart failure | 1.14 (1.13, 1.15) | <0.0001 |
| Deficiency anemias | 1.12 (1.11, 1.14) | <0.0001 |
| Any otherc | 1.07 (1.05, 1.08) | <0.0001 |
| Diabetes without chronic complications | 0.96 (0.95, 0.97) | <0.0001 |
| Valvular disease | 1.07 (1.06, 1.08) | <0.0001 |
| Hypothyroidism | 1.02 (1.01, 1.03) | 0.0010 |
| Renal failure | 1.11 (1.1, 1.12) | <0.0001 |
| Peripheral vascular disease | 1.07 (1.05, 1.08) | <0.0001 |
| Other neurological disorders | 0.99 (0.98, 1) | 0.130 |
| Depression | 1.04 (1.02, 1.05) | <0.0001 |
| Diabetes with chronic complications | 1.04 (1.03, 1.06) | <0.0001 |
| Obesity | 0.99 (0.98, 1.01) | 0.510 |
| Pulmonary circulation disease | 1.07 (1.05, 1.09) | <0.0001 |
| Weight loss | 1.04 (1.03, 1.06) | <0.0001 |
| Solid tumor without metastasis | 0.98 (0.97, 1) | 0.030 |
| Coagulopathy | 1.11 (1.09, 1.13) | <0.0001 |
| Metastatic cancer | 1.33 (1.3, 1.36) | <0.0001 |
| Duration of index hospitalization, mean (SD) | ||
| 0–2 days | 1 (Reference) | |
| 3–4 days | 1.13 (1.11, 1.14) | <0.0001 |
| 5–6 days | 1.3 (1.29, 1.32) | <0.0001 |
| ≥7 days | 1.65 (1.63, 1.66) | <0.0001 |
| Nursing home stay within 30 days prior to index hospitalization | 1.06 (1.05, 1.07) | <0.0001 |
| Disabled | 1.01 (0.98, 1.04) | 0.670 |
| Index hospital characteristics | ||
| Average annual total discharge count, mean (SD) | ||
| >10,000 annual discharges | 1 (Reference) | |
| 7001–10,000 annual discharges | 0.99 (0.98, 1) | 0.28 |
| 4001–4000 annual discharges | 1 (0.99, 1.01) | 0.19 |
| <4000 annual discharges | 1 (0.99, 1.01) | 0.90 |
| Medical school affiliation | ||
| None | 1 (Reference) | |
| Minor | 1 (0.99, 1.01) | 0.640 |
| Major | 1.06 (1.05, 1.07) | <0.0001 |
| RUCA | ||
| Urban core area | 1 (Reference) | |
| Suburban area | 1.02 (0.99, 1.06) | 0.140 |
| Large town area | 0.99 (0.98, 1.01) | 0.340 |
| Small town and isolated rural area | 1.08 (1.04, 1.13) | <0.0001 |
| Critical access hospital | 1.06 (0.99, 1.14) | 0.080 |
CI, confidence interval; HCC, Hierarchical Condition Categories; HR, hazard ratio; RUCA, Rural/Urban Commuting Area Code.
a
Local hospice utilization is defined as the percentage of patients that died who had entered into hospice care within each Hospice Service Area. See text for details.
b
Census block group from the 2000 U.S. Census.
c
Includes alcohol abuse, chronic blood loss anemia, drug abuse, liver disease, lymphoma, paralysis, peptic ulcer disease with bleeding, psychoses, rheumatoid arthritis/collagen vascular disease.