Palliative Care and Hospice in the Pandemic: A Review of State Planning and Lessons Not Yet Learned.

Context: Written Crisis Standards of Care guidelines have been published federally in the United States for several decades to assisted in planning for a variety of disasters, and planning documents exist in most states. Federal and state crisis planning guidelines, both before and during the early COVID pandemic, focused on saving the most lives. Palliative care (PC) and hospice shortages were exacerbated by the COVID pandemic but recognized late and incompletely.

Low Hospice Utilization in New York State: Framework for Compiling and Ranking Barriers.

The hospice benefit can improve end-of-life outcomes, but is underutilized, particularly in low enrollment states such as New York. Little is known about this underutilization. The first part of a mixed-methods study aimed to compile and rank barriers to hospice utilization and identify differences between New York and the rest of the United States.

Low Hospice Utilization in New York State: Comparisons Using National Data.

Context: Hospice utilization in New York State (NYS) is low compared to the rest of the U.S.

Objectives: The first part of a mixed-methods study elicited information from New York State stakeholders and identified 54 hospice-related barriers in nine categories, some specific to NYS.

Use of Hospital Referral Regions in Evaluating End-of-Life Care.

Hospital referral regions (HRRs) are often used to characterize inpatient referral patterns, but it is unknown how well these geographic regions are aligned with variation in Medicare-financed hospice care, which is largely provided at home. Our objective was to characterize the variability in hospice use rates among elderly Medicare decedents by HRR and county. Using 2014 Master Beneficiary File for decedents 65 and older from North and South Carolina, we applied Bayesian mixed models to quantify variation in hospice use rates explained by HRR fixed effects, county random effects, and residual error among Medicare decedents.

Predicting Length of Hospice Stay: An Application of Quantile Regression.

Background: Use of the Medicare hospice benefit has been associated with high-quality care at the end of life, and hospice length of use in particular has been used as a proxy for appropriate timing of hospice enrollment. Quantile regression has been underutilized as an alternative tool to model distributional changes in hospice length of use and hospice payments outside of the mean.

Objective: To test for heterogeneity in the relationship between patient characteristics and hospice outcomes across the distribution of hospice days.

Will Changes to Medicare Payment Rates Alter Hospice's Cost-Saving Ability?

Background: On January 1, 2016, Medicare implemented a new "two-tiered" model for hospice services, with per diem rates increased for days 1 through 60, decreased for days 61 and greater, and service intensity add-on payments made retrospectively for the last seven days of life.

Objective: To estimate whether the Medicare hospice benefit's potential for cost savings will change as a result of the January 2016 change in payment structure.

Design: Analysis of decedents' claims records using propensity score matching, logistic regression, and sensitivity analysis.

Hospital-Based Palliative Care with Medicare Claims: Evidence From Colorado.

Background: The prevalence of hospital-based palliative care has been largely anecdotal as an increasing service being provided and there is a need to understand what trends can be analyzed with Medicare data.

Objective: To compare 2 methods of identifying hospital-based palliative care in the Medicare population in Colorado.

Study Design: Through Medicare claims data and phone surveys, we ascertained the presence of hospital-based palliative care services, number of patients receiving palliative care, and number of care visits provided during the previous year.

Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial.

Importance: For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy.

Objective: To evaluate the safety, clinical, and cost impact of discontinuing statin medications for patients in the palliative care setting.

Confirmation of the "disability paradox" among hospice patients: preservation of quality of life despite physical ailments and psychosocial concerns.

Objective: The purpose of this study was to describe quality of life (QOL) and psychosocial and spiritual issues among patients receiving hospice care.

Methods: A questionnaire addressing QOL, spirituality, optimism, loss, fears about the terminal process and death anxiety was administered to 66 adults receiving care from 14 hospices. The physical components of QOL (physical symptoms and physical well-being) were rated lower than the psychosocial and spiritual aspects (support, existential well-being, psychological symptoms).

Healthcare professional education: a unique role for hospices.

We sought to describe the educational experiences that hospices currently provide for students in health professions by using a national cross-sectional, Web-based survey of the National Hospice and Palliative Care Organization (NHPCO) and the Population-based Palliative Care Research Network (PoPCRN) hospice sites. Of the 75 responding sites, 71 (95 percent) participated in the education of health profession students, most commonly providing education for bachelor of science in nursing students (73 percent), associate's degree nursing students (61 percent), master's-level social work or counseling students (61 percent), registered nursing students (59 percent), medical students (58 percent), and medical residents (57 percent). Significant staff time was devoted to educating these students (averaging 11 to 30 hours/week), but less than 3 percent received any financial compensation.

Recruiting for research in hospice: feasibility of a research screening protocol.

Background: The growth of palliative care research has been limited by challenges of slow recruitment and underenrollment. One potential solution to this problem is the use of screening questions embedded in clinical data collection, which identify patients who are interested in participating in research and who can then be approached directly. The goal of this study was to evaluate the feasibility of this strategy for identifying hospice patients who are interested in research participation.

Barriers to effective symptom management in hospice.

The barriers to effective symptom management in hospice are not well described. We surveyed nurses of hospices affiliated with the Population-based Palliative Care Research Network (PoPCRN) to identify barriers to the effective management of common symptoms in terminally ill patients. 867/1710 (51%) nurses from 67 hospices in 25 U.

Hospice pharmaceutical cost trends.

Hospices are required to provide pharmaceuticals under the Medicare Hospice Benefit. Since there are no data describing these costs for hospice programs, this study analyzes data from a cross-sectional survey of 34 hospices concerning their pharmaceutical cost trends. Most respondents reported higher pharmaceutical-related costs between 1998 and 2002, but a significant minority reported that their costs had decreased.

Outcomes and characteristics of patients discharged alive from hospice.

Objectives: To describe outcomes and characteristics of patients discharged alive from hospice.

Design: Prospective cohort study using a telephone survey.

Setting: Hospices (n=18) participating in the Population-Based Palliative Care Research Network during the 1-year study period.

Current use of guidelines, protocols, and care pathways for symptom management in hospice.

Evidence-based guidelines or care pathways for symptom management could provide a means to reduce symptom distress in dying patients. We surveyed directors of nursing from hospices affiliated with the Population-based Palliative Care Research Network (PoPCRN) regarding their hospices' current use of and attitudes toward written symptom management materials. A majority (53/78, 68 percent) of participating hospices reported use of written materials, such as guidelines, protocols, or care pathways, for one or more symptoms.

Estimation of confusion prevalence in hospice patients.

Background: Confusion is common among ill patients and has broad consequences for their care and well-being. The prevalence of confusion in hospice patients is unknown.

Objectives: Describe the prevalence, severity, and manifestations of nurse-identified confusion and estimate the prevalence of delirium in hospice patients.