• Elizabeth T Trandel, Jane Lowers, Megan E Bannon, Laura T Moreines, Elisabeth P Dellon, Patrick White, Sarah H Cross, Tammie E Quest, Keith Lagnese, Tamar Krishnamurti, Robert M Arnold, Krista L Harrison, Rachel E Patzer, Li Wang, Ali John Zarrabi, and Dio Kavalieratos.
• Emory University, Atlanta, GA, USA.
• J Gen Intern Med. 2023 Feb 1; 38 (2): 277284277-284.

BackgroundThe per diem financial structure of hospice care may lead agencies to consider patient-level factors when weighing admissions.ObjectiveTo investigate if treatment cost, disease complexity, and diagnosis are associated with hospice willingness to accept patients.DesignIn this 2019 online survey study, individuals involved in hospice admissions decisions were randomized to view one of six hypothetical patient vignettes: "high-cost, high-complexity," "low-cost, high-complexity," and "low-cost, low-complexity" within two diseases: heart failure and cystic fibrosis. Vignettes included demographics, prognoses, goals, and medications with costs. Respondents indicated their perceived likelihood of acceptance to their hospice; if likelihood was <100%, respondents were asked the barriers to acceptance. We used bivariate tests to examine associations between demographic, clinical, and organizational factors and likelihood of acceptance.ParticipantsIndividuals involved in hospice admissions decisions MAIN MEASURES: Likelihood of acceptance to hospice care KEY RESULTS: N=495 (76% female, 53% age 45-64). Likelihoods of acceptance in cystic fibrosis were 79.8% (high-cost, high-complexity), 92.4% (low-cost, high-complexity), and 91.5% (low-cost, low-complexity), and in heart failure were 65.9% (high-cost, high-complexity), 87.3% (low-cost, high-complexity), and 96.6% (low-cost, low-complexity). For both heart failure and cystic fibrosis, respondents were less likely to accept the high-cost, high-complexity patient than the low-cost, high-complexity patient (65.9% vs. 87.3%, 79.8% vs. 92.4%, both p<0.001). For heart failure, respondents were less likely to accept the low-cost, high-complexity patient than the low-cost, low-complexity patient (87.3% vs. 96.6%, p=0.004). Treatment cost was the most common barrier for 5 of 6 vignettes.ConclusionsThis study suggests that patients receiving expensive and/or complex treatments for palliation may have difficulty accessing hospice.© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.

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