• Joan M Teno, Jason Bowman, Michael Plotzke, Pedro L Gozalo, Thomas Christian, Susan C Miller, Cindy Williams, and Vincent Mor.
• Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA. Electronic address: Joan_Teno@brown.edu.
• J Pain Symptom Manage. 2015 Oct 1; 50 (4): 548-52.

ContextLittle is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation.ObjectivesTo characterize hospices with high rates of problematic patterns of live discharges.MethodsThree hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located.ResultsIn 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P < 0.001), whereas not-for-profit providers had the lowest rate of burdensome transitions (1.4%). About one in three (33.8%) for-profit providers exhibited one or more of these discharge patterns compared with 9.0% of not-for-profit providers.ConclusionProblematic patterns of live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain.Copyright © 2015 American Academy of Hospice and Palliative Medicine. All rights reserved.

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