What Factors Impact Access to General Inpatient Care in Hospice? (RP100)

Outcomes 1. Identify structural factors associated with GIP utilization.2. Apply knowledge regarding GIP utilization patterns to reflect on barriers and facilitators to GIP use in one's own practice. Key Message The Medicare hospice benefit includes general inpatient care to provide patients with access to aggressive symptom management. Rather than symptom burden alone determining its use, differential patterns in regional utilization suggest structural factors play an important role in access to this level of care. Importance Nearly one in five persons experience severe pain while dying (1). Under the Medicare hospice benefit, general inpatient care (GIP) provides intensive symptom management in a hospital, freestanding hospice inpatient unit, or nursing home. The extent to which social and structural factors impact GIP access is unknown. Objective(s) To examine access to GIP based on patient and hospice characteristics. Scientific Methods Utilized We conducted a retrospective cohort study of Medicare decedents who enrolled in hospice prior to death, using the National Health and Aging Trends Study (NHATS; 2011-2018). We identified hospice enrollment and GIP utilization through linked Medicare claims data. We collected data on hospice agencies from Medicare public use files and data on decedent characteristics from the NHATS survey. Using a multivariable model that accounted for the survey design of NHATS, we compared characteristics of participants who did and did not use GIP while enrolled in hospice. Results Among 1,080 decedents who received hospice services, 36.5% received GIP. In adjusted analyses, the two groups did not differ by age, sex, race, income, informal caregivers or location prior to hospice enrollment. Hospice age, profit status, census, average length of stay, and CAHPS recommend and rating top box values did not affect GIP utilization. Decedents located in the west of the United States were less likely to receive GIP (OR: 0.51, CI 0.27-0.96). Conclusion(s) Even after adjustment for patient and hospice characteristics, use of GIP varied by region of the United States. Impact Regional differences exist in access to GIP level of care. Further research is needed to examine whether limited access impacts symptom amelioration among dying hospice patients. Keywords Hospice/Models of palliative/hospice care delivery