Hospice discharges for 2022 among patients admitted for the most common malignancies: An analysis of the National Inpatient Sample.

Abstract

e13557 Background: Hospice and home health care play significant roles in improving the quality of life and comfort for terminally ill patients. This analysis aims to identify modifiable factors that can improve hospice utilization among patients diagnosed with some of the most fatal malignancies. Methods: The National Inpatient Sample (NIS) database from the Healthcare Cost and Utilization Project (HCUP) for the year 2022 was used to identify all patients admitted with a primary diagnosis of lung, colorectal, pancreatic, or breast malignancy. Patients were divided into three subpopulations based on their primary payer: Medicare/Medicaid, private insurance, and self-pay. The primary outcome measured was hospice discharge versus other dispositions. Logistic and linear regression models were applied to evaluate statistically significant differences based on age, race, hospital-bed size, teaching status, income, gender, type of admission, and hospital region. Results: A total of 275,794 patients with a principal diagnosis of malignancy were included in the analysis, divided into the following payer subgroup: Medicare/Medicaid: 186,180 Private insurance: 75,624 Self-pay: 6,244 Of these, 67,975 (24.64%) were discharged to hospice Key Findings by Subpopulation: Medicare/Medicaid: Elective admissions had an OR of 1.58 (p < 0.001) Female patients had an OR of 0.87 (p < 0.001) Urban non-teaching hospitals (OR 0.80, p = 0.002) and urban teaching hospitals (OR 0.84, p = 0.007) were associated with lower hospice discharge rates compared to rural hospitals Private nonprofit hospitals (OR 0.83, p = 0.013) and private investor-owned hospitals (OR 0.79, p = 0.008) showed lower hospice discharge rates compared to government federal hospitals Median household income for Quartiles 2, 3, and 4 showed increased odds of hospice discharge OR of 1.09 (p = 0.007), 1.12 (p = 0.001), and 1.15 (p = 0.001) respectively Private Insurance Weekend admissions had less hospice discharges with OR of 0.85 (p = 0.027) Urban non-teaching hospitals (OR 0.71, p = 0.017) and urban teaching hospitals (OR 0.67, p = 0.002) were associated with lower hospice discharge rates compared to rural hospitals Self-Pay Only median household income for Quartile 2 compared to Quartile 1 showed significant and high hospice discharges with OR 1.77 and p (0.024). Conclusions: This analysis highlights the deficiencies in hospice utilization, with fewer than 25% of patients discharged to hospice care. These findings emphasize the need to address systemic factors influencing end-of-life care. By identifying barriers, clinicians can guide patient counseling and better allocate resources toward hospice, ultimately improving patient outcomes. Mean age, length of stay (LOS) in days, and total charges by payer subgroup. Mean Age LOS Total Charges in Dollars Medicare/Medicaid 73 7.44 114928 Private insurance 59 7.18 131513 Self pay 61 7.06 103635