Table 3.
Patient and Hospice Characteristics Associated With Hospice Disenrollment Patterns, n = 149,814
| Overall Disenrollment From Hospice* | Patterns of Hospice Disenrollment | |||
|---|---|---|---|---|
|
| ||||
| Patients Who Disenrolled in Conjunction With an Acute Event* | Patients Who Disenrolled >165 Days† | Patients Who Disenrolled ≥165 Days* | ||
|
|
|
|
|
|
| OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |
| Patient characteristics | ||||
| Primary diagnosis of dementia | ||||
| Yes | 1.04 (0.92–1.16) | 0.78 (0.65–0.94)‡ | 1.25 (1.08–1.46)† | 0.97 (0.86–1.09) |
| No | Ref | Ref | Ref | Ref |
| Age, y | ||||
| 65–84 | Ref | Ref | Ref | Ref |
| ≥85 | 0.88 (0.84–0.91)‡ | 0.67 (0.62–0.72)‡ | 0.92 (0.86–0.98)‡ | 0.91 (0.87–0.96)‡ |
| Sex | ||||
| Female | 1.06 (1.02–1.10)‡ | 0.97 (0.91–1.04) | 1.14 (1.06–1.23)‡ | 1.04 (0.99–1.09) |
| Male | Ref | Ref | Ref | Ref |
| Ethnicity | ||||
| White | 0.70 (0.64–0.75)‡ | 0.49 (0.44–0.54)‡ | 0.86 (0.76–0.97)‡ | 0.78 (0.71–0.85)‡ |
| Other | Ref | Ref | Ref | Ref |
| Count of chronic conditions | ||||
| <5 | Ref | Ref | Ref | Ref |
| ≥5 | 0.99 (0.95–1.03) | 1.17 (1.10–1.26)‡ | 1.06 (0.98–1.14) | 0.90 (0.86–0.95)‡ |
| Hospice characteristics | ||||
| Hospice ownership | ||||
| For-profit | 1.38 (1.23–1.55)‡ | 2.15 (1.79–2.59)‡ | 0.97 (0.83–1.14) | 1.24 (1.10–1.40)‡ |
| Nonprofit | Ref | Ref | Ref | Ref |
| Hospice size (average no. patients per day) | ||||
| <20 | Ref | Ref | Ref | Ref |
| 20–49 | 1.01 (0.85–1.19) | 1.10 (0.85–1.43) | 1.04 (0.81–1.33) | 0.95 (0.78–1.16) |
| 50–99 | 0.84 (0.70–0.99)‡ | 0.90 (0.70–1.16) | 0.80 (0.63–1.03) | 0.83 (0.68–1.00) |
| ≥100 | 0.75 (0.63–0.91)‡ | 0.83 (0.61–1.13) | 0.64 (0.49–0.82)‡ | 0.77 (0.63–0.94)‡ |
| Open access policy | ||||
| Yes | 1.01 (0.90–1.14) | 0.95 (0.77–1.16) | 1.01 (0.85–1.20) | 1.03 (0.91–1.17) |
| No | Ref | Ref | Ref | Ref |
| Years of providing hospice care | ||||
| Hospice provides care <5 years | Ref | Ref | Ref | Ref |
| Hospice provides care >5 years | 0.90 (0.79–1.02) | 0.85 (0.69–1.05) | 1.02 (0.87–1.20) | 0.91 (0.79–1.04) |
| Percentage of nursing home patients served by the hospice | ||||
| <10% | Ref | Ref | Ref | Ref |
| 10%–20% | 0.95 (0.83–1.10) | 0.93 (0.70–1.22) | 0.89 (0.73–1.08) | 0.97 (0.85–1.11) |
| 20%–30% | 0.78 (0.64–0.95)‡ | 0.65 (0.49–0.90)‡ | 0.75 (0.56–0.99)‡ | 0.83 (0.69–1.00) |
| >30% | 0.74 (0.62–0.88)‡ | 0.51 (0.41–0.71)‡ | 0.76 (0.60–0.96)‡ | 0.80 (0.67–0.95)‡ |
| Location | ||||
| Rural/Suburban | Ref | Ref | Ref | Ref |
| Urban | 0.88 (0.78–1.00) | 0.82 (0.66–1.02) | 0.98 (0.82–1.16) | 0.88 (0.78–0.98)‡ |
| Region | ||||
| North East | Ref | Ref | Ref | Ref |
| Midwest | 0.66 (0.55–0.78)‡ | 0.45 (0.29–0.70)‡ | 0.75 (0.60–0.94)‡ | 0.77 (0.66–0.90)‡ |
| South | 0.82 (0.67–1.00) | 0.64 (0.41–0.99)‡ | 0.70 (0.55–0.90)‡ | 1.02 (0.86–1.21) |
| West | 0.85 (0.70–1.05) | 0.53 (0.31–0.88)‡ | 0.74 (0.54–1.01) | 1.13 (0.96–1.32) |
Note. Bold values are statistically significant P < .05.
CI, confidence interval; OR, odds ratio.
The comparison group for the hospice disenrollment patterns are patients who remained with hospice until death.
*
Model 1, Model 2, and Model 4 control for patients’ total length of stay in hospice.
†
Model 3 only includes patients with a total length of stay >165 days.
‡
P < .05.