Hospice Visit Patterns in the Last Seven Days of Life and the Service Intensity Add-On Payment.

Background: Hospice in-person visits in the last week of life are critical to ensure quality of care. In 2016, The Centers for Medicare & Medicaid Services (CMS) introduced a Service Intensity Add-on (SIA) payment for in-person routine home care (RHC) visits by a registered nurse or social worker in the last 7 days of life.

Objectives: The aim of the study was to examine visit patterns in the last week of life and provide SIA payment impact estimates.

Development of an Assessment to Examine Training of the Hospice Primary Caregiver.

Background: Key to high-quality care of dying hospice patients at home is whether the hospice provides adequate training so the caregiver can safely care for the patient.

Objective: The study objective was to develop and validate a survey of hospice training for caregivers to ensure safe, high-quality care in the home setting.

Design: Our survey design was cross-sectional.

Timing of Survey Administration After Hospice Patient Death: Stability of Bereaved Respondents.

Context: The Centers for Medicare & Medicaid Services have elected to include a bereaved family member survey in public reporting of hospice quality data as mandated in the Affordable Care Act. However, it is not known what time point after death offers the most reliable responses.

Objectives: To examine the stability of bereaved family members' survey responses when administered three, six, and nine months after hospice patient death.

Family perceptions of quality of hospice care in the nursing home.

Context: Nursing homes (NHs) are increasingly the site of hospice care. High quality of care is dependent on successful NH-hospice collaboration.

Objectives: To examine bereaved family members' perceptions of NH-hospice collaborations in terms of what they believe went well or could have been improved.

Defining patient safety in hospice: principles to guide measurement and public reporting.

Despite progress towards safer care in most settings, there has been much less attention to improving safety in hospices, which care for more than 1,500,000 patients every year. In this article, we describe three serious conflicts that arise when safety measures from other settings are applied to hospice. First, safety measures that are imposed in order to reduce morbidity and mortality may be irrelevant for a hospice patient whose goals focus on comfort.

It is "too late" or is it? Bereaved family member perceptions of hospice referral when their family member was on hospice for seven days or less.

Context: Many family members of patients enrolled in hospice for less than seven days state that the hospice referral was made "at the right time."

Objectives: To examine bereaved family members' perceptions of the timing of hospice referral to identify aspects of the referral process that can be improved.

Methods: Open-ended interviews were conducted in seven hospice programs, interviewing bereaved family members of hospice patients who died within the first week of hospice enrollment.

Use of electronic documentation for quality improvement in hospice.

Little evidence exists about the use of electronic documentation (ED) in hospice and its relationship to quality improvement (QI) practices. The purposes of this study were to (1) estimate the prevalence of ED use in hospice, (2) identify organizational characteristics associated with use of ED, and (3) determine whether quality measurement practices differed based on documentation format (electronic vs nonelectronic). Surveys concerning the use of ED for QI practices and the monitoring of quality-related care and outcomes were collected from 653 hospices.

Does hospice improve quality of care for persons dying from dementia?

Objectives: To examine the effectiveness of hospice services for persons dying from dementia from the perspective of bereaved family members.

Design: Mortality follow-back survey.

Setting: Death certificates were drawn from five states (AL, FL, TX, MA, and MN).

One big happy family? Interdisciplinary variation in job satisfaction among hospice providers.

Background: Job satisfaction is particularly important in the hospice industry, given the emotional and interpersonal challenges that hospice staff face in providing care to patients near the end of life and their families. However, little is known about the job satisfaction of hospice providers, or about variation in satisfaction among disciplines.

Methods: Staff at participating hospices completed the Survey of Team Attitudes and Relationships (STAR) using an online user interface.

Got volunteers? Association of hospice use of volunteers with bereaved family members' overall rating of the quality of end-of-life care.

Context: Volunteers are a key component of hospice, and they are required by Medicare conditions of participation in the United States. Yet, little is known about the impact of volunteers in hospice.

Objectives: The goal of this study was to characterize whether bereaved family members in hospice programs with increased use of volunteer hours per patient day report higher overall satisfaction with hospice services.

Hospices' preparation and practices for quality measurement.

Context: Hospice and palliative care organizations need to measure and analyze quality of care, in response to national palliative care practice guidelines and new hospice regulatory requirements. Little is known about hospices' readiness to meet this new mandate.

Objectives: We analyzed data from a national survey of hospices to describe preparation and practices for quality measurement and research and to examine associated organizational characteristics.

Geographic variation in hospice use in the United States in 2002.

Complete Center for Disease Control death certificate records and Centers for Medicare and Medicaid Services 100% Standard Analytic File for hospice claims for 2002 were used to describe the whole population of hospice users and nonusers in the United States. The overall hospice utilization rate for persons 65 years and older was 28.6%.

Timing of referral to hospice and quality of care: length of stay and bereaved family members' perceptions of the timing of hospice referral.

Previous research has noted that many persons are referred to hospice in the last days of life. The National Hospice and Palliative Care Organization collaborated with Brown Medical School to create the Family Evaluation of Hospice Care (FEHC) data repository. In 2005, 106,514 surveys from 631 hospices were submitted with complete data on the hospice length of stay and bereaved family member perceptions of the timing of hospice care.

Hospice care for patients with dementia.

Dementia is a leading cause of death in the USA. Although guidelines exist to determine hospice eligibility for dementia, only a small percentage of patients dying with this condition receive hospice care. Hospice recipients with dementia have not been well characterized, and little is known about the quality of care they receive.

Comparing hospice and nonhospice patient survival among patients who die within a three-year window.

There is a widespread belief by some health care providers and the wider community that medications used to alleviate symptoms may hasten death in hospice patients. Conversely, there is a clinical impression among hospice providers that hospice might extend some patients' lives. We studied the difference of survival periods of terminally ill patients between those using hospices and not using hospices.

Opioid use and survival at the end of life: a survey of a hospice population.

Concern that opioids hasten death may be among the reasons that pain is treated inadequately in populations with advanced illness. Studies that assess the true risks are needed. To determine whether survival after last opioid dose change is associated with opioid dosing characteristics and other factors, data from the National Hospice Outcomes Project, a large prospective cohort study involving 13 U.

Family evaluation of hospice care: results from voluntary submission of data via website.

The Family Evaluation of Hospice Care (FEHC) survey is a 61-item questionnaire that surveys family members about care provided to the decedent by the hospice. Hospices submit their data to the National Hospice and Palliative Care Organization (NHPCO), where results are tabulated. For the first two quarters of 2004, a total of 29,292 surveys were tabulated.

More than a title.

In an American Board of Nursing Specialties survey, nurse managers share their perceptions of the value of specialty nursing certification.

Survey on use of palliative radiotherapy in hospice care.

Purpose: Radiation oncologists and hospice professionals both provide end-of-life care for oncology patients, and little has been written about the interface between these two groups of specialists. Hospice professionals were surveyed to assess the perceived need for palliative radiotherapy in the hospice setting, to investigate factors that limit the access of hospice patients to radiotherapy, and to suggest areas of future collaboration on education, research, and patient advocacy.

Patients And Methods: Members of the National Hospice and Palliative Care Organization (NHPCO) and American Society for Therapeutic Radiology and Oncology jointly authored a questionnaire to investigate the beliefs of hospice professionals toward the use of radiotherapy for oncology patients in hospice.