Key result
Higher rates of hospital-level hospice utilization were associated with lower rates of 30-day mortality (p<0.001) and readmission (p=0.002) for pneumonia, but not consistently for heart failure.
Why the study?
Does higher hospital-level hospice utilization affect CMS-reported 30-day mortality and readmission rates for pneumonia and heart failure in US hospitals?
Cohort (n=2,196)
Yes
Does higher hospital-level hospice utilization affect CMS-reported 30-day mortality and readmission rates for pneumonia and heart failure in US hospitals?
Higher hospital-level hospice utilization is associated with lower publicly reported 30-day mortality and readmission rates for pneumonia, suggesting that hospice referral patterns may artifactually influence CMS outcome metrics.
Answers are grounded in this paper and cite their sources.
Hospice utilization may link to better pneumonia metrics; hypothesis-generating for heart failure and requires prospective validation.
BACKGROUND: The Center for Medicare and Medicaid Services (CMS) and the Hospital Quality Alliance began collecting and reporting United States hospital performance in the treatment of pneumonia and heart failure in 2008. Whether the utilization of hospice might affect CMS-reported mortality and readmission rates is not known. METHODS: Hospice utilization (mean days on hospice per decedent) for 2012 from the Dartmouth Atlas (a project of the Dartmouth Institute that reports a variety of public health and policy-related statistics) was merged with hospital-level 30-day mortality and readmission rates for pneumonia and heart failure from CMS. The association between hospice use and outcomes was analyzed with multivariate quantile regression controlling for quality of care metrics, acute care bed availability, regional variability and other measures. RESULTS: 2196 hospitals reported data to both CMS and the Dartmouth Atlas in 2012. Higher rates of hospice utilization were associated with lower rates of 30-day mortality and readmission for pneumonia but not for heart failure. Higher quality of care was associated with lower rates of mortality for both pneumonia and heart failure. Greater acute care bed availability was associated with increased readmission rates for both conditions (p < 0.05 for all). CONCLUSIONS: Higher rates of hospice utilization were associated with lower rates of 30-day mortality and readmission for pneumonia as reported by CMS. While causality is not established, it is possible that hospice referrals might directly affect CMS outcome metrics. Further clarification of the relationship between hospice referral patterns and publicly reported CMS outcomes appears warranted.
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Lah et al. (2018) conducted a cohort in Pneumonia and heart failure (n=2,196). Hospice utilization (mean days on hospice per decedent) vs. Lower hospice utilization was evaluated on Hospital-level 30-day mortality and readmission rates for pneumonia and heart failure (p=<0.001). Higher rates of hospital-level hospice utilization were associated with lower rates of 30-day mortality (p<0.001) and readmission (p=0.002) for pneumonia, but not consistently for heart failure.
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