309422
State Level Variation in Hospital Death Rates and Hospice Utilization
Although most Americans prefer to die at home, roughly one quarter of deaths among seniors occur in acute care hospitals. There is potential for improvement in patient satisfaction if hospice services are better incorporated into end-of-life (EOL) care.
Objective
Our objective was to describe EOL care by state and to highlight geographic variation in hospice enrollment and hospital death rates.
Methods
A subset of measures from America’s Health Rankings Senior Report (SAHR) was selected to reflect EOL care. The selected variables were the percent of decedents aged 65 and older who died in a hospital and the percent of decedents aged 65 and older who were enrolled in hospice care during the last 6 months of life. Data from 2003-2007 and 2010 were used.
Results
Utah ranked first in both hospice utilization (63.0%) and hospital deaths (16.4%) in the 2014 edition. Alaska had the lowest hospice utilization rate (22.2%) and New York had the highest prevalence of hospital deaths among seniors (35.1%). Hospice utilization and hospital death rates were significantly related (r=-0.536, p<0.005) in the expected direction, such that states with more hospice utilization had a lower rate of hospital deaths.
Discussion
Hospital death rates and hospice care enrollment varied widely by state. States doing well on one measure tended to perform well on the other, but there were significant exceptions to this trend. Policies, resources, patient values, and other correlates may drive variation in end-of-life clinical care.
Learning Areas:
Provision of health care to the publicLearning Objectives:
Describe variation in hospital death rates and hospice enrollment by state. Discuss the relationship between these measures and the potential drivers of variation.
Keyword(s): End-of-Life Care, Hospitals
Qualified on the content I am responsible for because: I am currently pursuing a Masters Degree at the University of Minnesota School of Public Health, where I have received training in research methodology. Additionally, I work as an intern on the "America's Health Rankings" publication for Arundel Street Consulting. In that role, I have collected and analyzed the data presented in this abstract.
Any relevant financial relationships? Yes
| Name of Organization | Clinical/Research Area | Type of relationship |
|---|---|---|
| United Health Foundation | Population Health | Independent Contractor (contracted research and clinical trials) |
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.