Table 4.
Adjusted Associations between Receiving Continuous Home Care and Hospice Disenrollment/Hospitalization
| Hospice Disenrollment OR (95% CI) |
Hospitalization OR (95% CI) |
|
|---|---|---|
| Receiving continuous hospice care | ||
| No | reference | reference |
| Yes | 0.21 (0.19, 0.23) | 0.37 (0.34, 0.40) |
| Demographic Factors | ||
| Age | ||
| 66-69 | 1.44 (1.35, 1.54) | 1.61 (1.48, 1.76) |
| 70-74 | 1.34 (1.26, 1.42) | 1.53 (1.42, 1.65) |
| 75-79 | 1.27 (1.21, 1.34) | 1.48 (1.39, 1.58) |
| 80-84 | 1.16 (1.11, 1.21) | 1.30 (1.23, 1.38) |
| 85+ | reference | reference |
| Sex | ||
| Male | 1.19 (1.15, 1.23) | 1.10 (1.06, 1.15) |
| Female | reference | reference |
| Race | ||
| White | reference | reference |
| Black | 1.46 (1.38, 1.55) | 1.95 (1.82, 2.08) |
| Hispanic | 1.32 (1.21, 1.44) | 1.38 (1.24, 1.54) |
| Other | 1.31 (1.17, 1.48) | 1.36 (1.17, 1.58) |
| Clinical Factors | ||
| Number of comorbidities | ||
| 0-2 | reference | reference |
| 3 | 1.01 (0.94, 1.08) | 1.10 (1.00, 1.21) |
| 4 | 1.00 (0.93, 1.06) | 1.15 (1.05, 1.25) |
| 5 | 0.97 (0.91, 1.04) | 1.28 (1.17, 1.39) |
| 6 | 0.97 (0.91, 1.03) | 1.42 (1.30, 1.55) |
| 7-8 | 0.98 (0.91, 1.05) | 1.56 (1.43, 1.70) |
| Primary diagnosis for hospice enrollment | ||
| Neoplasms | reference | reference |
| Mental disorders | 0.69 (0.64, 0.73) | 0.65 (0.60, 0.70) |
| Diseases of the nervous system and sense organs | 0.65 (0.61, 0.69) | 0.60 (0.55, 0.66) |
| Diseases of the circulatory system | 0.93 (0.88, 0.98) | 1.10 (1.03, 1.18) |
| Diseases of the respiratory system | 0.93 (0.87, 0.99) | 1.21 (1.13, 1.31) |
| Symptoms, signs, and ill-defined conditions | 0.84 (0.79, 0.88) | 0.84 (0.79, 0.90) |
| Other | 0.90 (0.83, 0.98) | 0.75 (0.67, 0.85) |
| Receiving general inpatient hospice care | ||
| No | reference | reference |
| Yes | 0.65 (0.62, 0.68) | 0.78 (0.74, 0.83) |
| Days from hospice enrollment to death (continuous variable) |
1.01 (1.01, 1.01) | 1.01 (1.01, 1.01) |
| Geographic Factors | ||
| Metro residence | ||
| No | 1.00 (0.93, 1.09) | 1.05 (0.95, 1.16) |
| Micorpolitan | 0.91 (0.85, 0.98) | 0.92 (0.84, 1.00) |
| Metropolitan | reference | reference |
| Median income of county | ||
| Less than $33,000 | 1.15 (0.92, 1.43) | 0.97 (0.74, 1.26) |
| $33,000-40,000 | 1.02 (0.92, 1.13) | 1.08 (0.95, 1.23) |
| $40,000-50,000 | 0.97 (0.89, 1.05) | 1.00 (0.90, 1.12) |
| $50,000-63,000 | 1.00 (0.93, 1.08) | 1.03 (0.93, 1.13) |
| $63,000 or more | reference | reference |
| Percent ≤ HS education of zip code | ||
| Less than 60% | 1.36 (0.8, 2.34) | 1.51 (0.81, 2.82) |
| 60 to <70% | 1.16 (0.97, 1.39) | 1.41 (1.15, 1.74) |
| 70 to <80 % | 1.12 (1.02, 1.23) | 1.17 (1.04, 1.32) |
| 80 to <90% | 1.08 (1.01, 1.15) | 1.09 (1.01, 1.19) |
| 90% or more | reference | reference |
| Hospice-level factors | ||
| Hospice ownership | ||
| Nonprofit | 0.86 (0.80, 0.91) | 0.84 (0.77, 0.91) |
| For-profit | reference | reference |
| Year of hospice operation | ||
| ≥24 | 0.90 (0.82, 0.98) | 0.77 (0.69, 0.86) |
| 19-24 | 0.93 (0.85, 1.01) | 0.77 (0.70, 0.86) |
| 10-19 | 0.89 (0.83, 0.95) | 0.85 (0.78, 0.92) |
| <10 | reference | reference |
| Number of hospice admission during study period | ||
| ≥1,247 | 0.94 (0.86, 1.02) | 0.95 (0.85, 1.06) |
| 545-1247 | 0.87 (0.80, 0.93) | 0.85 (0.77, 0.93) |
| 241-545 | 0.84 (0.79, 0.90) | 0.86 (0.79, 0.93) |
| <241 | reference | reference |
| Market concentration | ||
| Competitive market | 1.12 (1.03, 1.23) | 1.08 (0.96, 1.20) |
| Moderately concentrated market | 0.94 (0.84, 1.05) | 1.03 (0.90, 1.17) |
| Highly concentrated market | reference | reference |