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Variation in Hospice Visits in Last Two Days of Life

Visits less likely when beneficiary is black, dying on a Sunday, receiving care in nursing home

woman patient on a bed

TUESDAY, Feb. 9, 2016 (HealthDay News) -- There is considerable variation in hospice visits by professional staff in the last two days of life, according to a study published online Feb. 8 in JAMA Internal Medicine.

Joan M. Teno, M.D., from the University of Washington in Seattle, and colleagues conducted a retrospective cohort study of 661,557 Medicare hospice beneficiaries. The authors examined visit variation in hospice services during the last two days of life for all patients who died in federal fiscal year 2014 while receiving routine home care.

The researchers found that 12.3 percent of patients in the study received no professional staff visits in the last two days of life. State variation ranged from 3.8 to 19.7 percent in Wisconsin to Alaska, respectively. The hospice program interquartile variation ranged from 3.2 to 19.5 percent (25th and 75th percentile, respectively). Compared with white patients, black patients were less likely to have any visits (15.2 versus 12.0 percent; adjusted odds ratio, 1.30). Compared with those dying at home, those dying in a nursing home were less likely to have any visits (16.5 versus 10.6; adjusted odds ratio, 1.74). Compared with persons dying on a Tuesday, those dying on a Sunday were less likely to have a visit (20.3 versus 7.4 percent; adjusted odds ratio, 3.35).

"Hospice visits in the last two days of life by professional staff vary by race, hospice program, and geographic region of the country," the authors write.

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