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hospice, mixed methods, resource utilization, supplemental visit approach



  1. Reither, Jonathon MD
  2. Nowels, David MD, MPH
  3. Nowels, Carolyn T. MSPH
  4. Motz-Storey, Lisa MDiv
  5. Mellis, B. Karen BS
  6. Keech, Tarah MA
  7. Matlock, Daniel D. MD, MPH
  8. Kutner, Jean S. MD, MSPH


The traditional model of hospice care provision is visit-centric and resource-intensive. Our research question emerged from a collaboration between a community-based hospice and academic researchers seeking to address real-world concerns in hospice service delivery. We sought to describe current and prior use of and hospice clinician perspectives on implementing alternatives to the face-to-face visit model to inform innovative, resource-conscious approaches to hospice care. We used mixed (qualitative and quantitative) methods, which included a Web-based survey and key informant telephone interviews. We then conducted focus groups of hospice clinicians seeking their perspectives regarding implementation of the supplemental visit approaches that were identified via the survey and key informant interviews. 81% of survey responders report using some type of supplemental visit, most commonly scheduled telephone calls. Few hospices utilize other technologies, such as video-phone, Web portals, or e-mail. Focus group participants identified the need for a significant internal "culture shift" to implement such technologies. Based on these findings, we developed a testable conceptual model for implementing supplemental hospice visits utilizing technologic innovations. A number of technologies hold promise for enhancing the efficiency, accessibility, and quality of hospice care when used to supplement face-to-face visits.