Journal of palliative medicine
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To identify factors associated with hospitalization of elderly hospice patients with cancer and to describe their hospital experiences. ⋯ The rates of hospitalization for elderly hospice patients with lung or colorectal cancer appear to be declining. However, patients who are hospitalized undergo aggressive care and often die in the hospital rather than at home. This aggressive care may be consistent with changes in patients' care preferences, but could also reflect the current culture of acute care hospitals, which focuses on curative treatment and is ill-equipped to provide palliative care.
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Comparative Study
A high-volume specialist palliative care unit and team may reduce in-hospital end-of-life care costs.
Current end-of-life hospital care can be of poor quality and high cost. High volume and/or specialist care, and standardized care with clinical practice guidelines, has improved outcomes and costs in other areas of cancer care. ⋯ Appropriate standardized care of medically complex terminally ill patients in a high-volume, specialized unit may significantly lower cost. These results should be confirmed in a randomized study but such studies are difficult to perform.
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Comparative Study
Effectiveness of a home-based palliative care program for end-of-life.
Despite the widespread recognition of the need for new models of care to better serve patients at the end-of-life, little evidence exists documenting the effectiveness of these models. ⋯ Through integrating palliative care into curative care practices earlier in the disease trajectory, chronically ill patients nearing the end of life report improved satisfaction with care and demonstrate less acute care use resulting in lower costs of care. In addition, patients enrolled in the palliative care program were more likely to die at home than comparison group patients.
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Comparative Study
Factors associated with the high prevalence of short hospice stays.
This study's goal was to gain an understanding of the factors associated with hospice stays of 7 days or less (i.e., short hospice stays), and to test the hypothesis that independent of changes in sociodemographics, diagnoses, and site-of-care, the likelihood of a short hospice stay increased over time. We examined hospice stays for 46655 nursing home and 80507 non-nursing home patients admitted between October 1994 and September 1999 to 21 hospices across 7 states, and owned by 1 provider. Logistic regression was used to determine the factors significantly associated with a higher probability of a short stay. ⋯ In (fiscal year) 1995, a nursing home resident admitted to hospice had a 26% probability (95% confidence interval [CI] 0.24, 0.28) of a less than 8-day stay and, in (fiscal year) 1999, the probability was 33% (95% CI 0.31, 0.34); a non-nursing home patient had a 32% probability in 1995 (95% CI 0.30, 0.34) and a 36% probability in 1999 (95% CI 0.34, 0.37). The probability of a short hospice stay was greater for patients with noncancer diagnoses, independent of year of hospice admission. In this paper we discuss the possible underlying reasons for the increased probability of short hospice stays and we speculate on what this increase may mean in terms of hospice's ability to provide high-quality end-of-life care.