• Veerawat Phongtankuel, Ronald D Adelman, Kelly Trevino, Erika Abramson, Phyllis Johnson, Clara Oromendia, Charles R Henderson, and M C Reid.
• 1 Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
• Am J Hosp Palliat Care. 2018 Feb 1; 35 (2): 316-323.

BackgroundOver 10% of hospice patients experience a transition out of hospice care during the last months of life. Hospice transitions from home to hospital (ie, hospital-related hospice disenrollment) result in fragmented care, which can be burdensome for patients and caregivers. Nurses play a major role in delivering home hospice care, yet little is known about the association between nursing visits and disenrollment.ObjectivesThe study's purpose is to examine the association between the average number of nursing visits per week and hospital-related disenrollment in the home hospice population. We hypothesize that more nursing visits per week will be associated with reduced odds for disenrollment.DesignA retrospective cohort study using Medicare data.ParticipantsMedicare hospice beneficiaries who were ≥18 years old in 2012.Outcome MeasuredHospitalization within 2 days of hospice disenrollment.ResultsThe sample included 115 103 home hospice patients, 6450 (5.6%) of whom experienced a hospital-related disenrollment. The median number of nursing visits per week was 2 (interquartile range 1.3-3.2), with a mean of 2.5 (standard deviation ±1.6). There was a decreased likelihood of a hospital-related disenrollment when comparing enrollments that had <3 nursing visits per week on average to 3 to <4 visits (odds ratio [OR] 0.39; P value <.001), 4 to <5 visits (OR 0.29; P value <.001), and 5+ visits (OR 0.21; P value <.001).ConclusionsMore nursing visits per week was associated with a decreased likelihood of a hospital-related hospice disenrollment. Further research is needed to understand what components of nursing care influence care transitions in the home hospice setting.

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