• Shayna E Rich and Ann L Gruber-Baldini.
• Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
• Med Care. 2009 Jan 1;47(1):9-14.

BackgroundSimilar patient populations and favorable regulations have led many home health agencies to become Medicare and/or Medicaid certified as hospice agencies (mixed), but home health and hospice programs differ in focus and scope. Little research has been performed examining the differences between mixed hospices and those agencies only certified as hospices (nonmixed).ObjectivesTo describe the differences in agency characteristics between mixed and nonmixed agencies; and to compare frequencies of service provision by mixed and nonmixed agencies.Research DesignCross-sectional study using data from the 2000 National Home and Hospice Care Survey.SubjectsA total of 760 Medicare and/or Medicaid certified hospice agencies providing services during the survey, including 393 mixed agencies (52% of sample) and 367 nonmixed hospices.MeasuresSurvey responses by administrators about services provided by agency.ResultsNonmixed agencies were significantly more likely than mixed agencies to provide many types of services, including: volunteers [96.1% vs. 77.4%, respectively; odds ratio (OR): 7.27; 95% confidence interval (CI): 5.26-10.05], social services (96.1% vs. 93.5%; OR: 1.70; 95% CI: 1.20-2.40), spiritual care (95.1% vs. 77.8%; OR: 5.53; 95% CI: 4.13-7.41), bereavement care (93.5% vs. 79.8%; OR: 3.63; 95% CI: 2.80-4.72), counseling (89.5% vs. 70.2%; OR: 3.62; 95% CI: 2.92-4.48), and physician services (87.2% vs. 52.0%; OR: 6.30; 95% CI: 5.18-7.66). In logistic regression models, these differences remained significant after adjustment for census region, operation by a hospital, number of patients and number of hospice patients, and Medicare and Medicaid hospice certification status.ConclusionsMixed agencies provide a narrower range of services to hospice patients than nonmixed agencies, including fewer services considered cornerstones of hospice treatment.

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