Center to Advance Palliative Care

Hello,
What an interesting question. So you plan to monitor changes in discharge disposition, using the assumption that an increase in the proportion of patients discharged to SNF or rehab or home health and presumably a decrease in the proportion discharged to hospice would indicate that more patients are being referred before they are hospice eligible. I guess I would just worry about other reasons why your discharge disposition distribution would change … did hospice become less available for some reason, either because of changes in how it is presented as an option or from changes in the availability of services, or from changes in the population of patients you serve? I would recommend supplementing your patient level data collection with a simple “Hospice eligible?” Yes/no item … if you have that data point you could say, “Of the 40 patients discharged to rehab, only 10 were hospice eligible, the others were referred earlier in the disease course –a key service goal.” I think that data point would settle concerns that hospice might be underutilized, for whatever reason, in the group of patients who are being discharged to other settings. I’d be interested in what others have to say on this matter.

Best wishes, Kathleen Kerr, Senior Analyst, University of California San Francisco, Palliative Care Leadership Center