Hospice Disenrollment Tied to Higher Health Care Use

Cancer patients who disenroll from hospice also likely to incur higher Medicare costs
By Beth Gilbert
HealthDay Reporter

TUESDAY, Sept. 28 (HealthDay News) -- Patients with cancer who disenroll from hospice are likely to experience increased hospitalization rates and higher Medicare expenditures than those who remain enrolled in hospice until death, according to a study published online Aug. 30 in the Journal of Clinical Oncology.

Using Surveillance, Epidemiology, and End Results-Medicare data for 90,826 hospice users who died as a result of cancer between 1998 and 2002, Melissa D.A. Carlson, Ph.D., of the Mount Sinai School of Medicine in New York City, and colleagues compared rates of hospitalization, emergency department and intensive care unit admission, and hospital death for hospice disenrollees and those who remained in hospice until death.

Compared to patients who remained enrolled in hospice until death, the investigators found that those who disenrolled from hospice were more likely to be hospitalized (39.8 versus 1.6 percent), admitted to the emergency department (33.9 versus 3.1 percent) or intensive care unit (5.7 versus 0.1 percent), and die in the hospital (9.6 versus 0.2 percent). Those who disenrolled from hospice died a median of 24 days after disenrollment and incurred higher per-day Medicare expenditures compared to patients who remained enrolled in hospice until death.

"Strategies to support patients who have disenrolled from hospice and their families, including the use of a palliative care consultation at the time of hospice disenrollment, may be beneficial and should be explored," the authors write.

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