"Increasing the availability of alternative venues of care, such as long-term care and home care, may be effective in further reducing hospitalizations and containing costs," they conclude.
In a third article, Jonathan Bergman, M.D., of the University of California, Los Angeles, and colleagues linked data from Surveillance, Epidemiology and End Results cancer registries to Medicare data to identify 14,521 men dying of prostate cancer in the United States between 1992 and 2005.
Overall, 7,646 of the men (53 percent) had used hospice, for a median (midpoint) of 24 days. African Americans and those with more co-occurring illnesses were less likely to use hospice, whereas having a partner and dying more recently were associated with greater use. Men who enrolled in hospice were less likely to receive high-intensity care, including admission to the intensive care unit, inpatient stays and multiple emergency department visits.
Although hospice use increased over time, almost one-third of patients enrolled in hospice within seven days of death or more than 180 days before dying. "Hospice stays shorter than seven days are too brief to maximize the benefit of enrollment, and individuals making shorter stays receive fewer services and benefit less from the input of the full interdisciplinary team," the authors write. "At the other end of the spectrum, the Medicare hospice benefit requires that a primary care physician and a hospice medical director certify that an individual's expected prognosis does not exceed 180 days when he or she is enrolled in hospice."
"Increasing appropriate hospice use
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