Patient’s Geographic Location Influences Hospice Choice

The community in which a patient resides may be a key factor that influences their decision of whether or not to elect hospice care. New research indicates regional variations in patients’ end-of-life decision making. 

Researchers from Beth Israel Deaconess Medical Center’s (BIDMC) Center for Health Care Delivery Science took a close look at regional patterns in the site of death for older adults who suffered from chronic diseases between 2010 and 2016. They concluded that patients’ places of residence may be a key determinant of whether they receive hospice or pursue high-acuity care.

“While surveys show that older adults across the country commonly prefer to avoid hospitalization and intensive care at the end of life, we observed that rates of death in the hospital versus hospice vary significantly depending on where patients live,” said corresponding author Jason H. Maley, M.D., a fellow in the Harvard combined Pulmonary and Critical Care fellowship at BIDMC and Massachusetts General Hospital. “We would like to explore the many factors that could drive this variation and create equity in end-of life care. For example, home hospice also requires significant effort from a patient’s loved ones, who serve as caregivers, and the answer to quality end-of-life care is not simple or one-size fits all. Most of all, it should be care that aligns with a patient’s values and supports families.”

The study authors applied data from more than 7 million patients diagnosed with at least one of nine chronic illnesses to discover that the percent of patients dying in the hospital varied more than three-fold across regions of the country, and regions where a high percent of patients were hospitalized at the end of life had correspondingly low hospice use.

For example, fewer than 14% of patients in communities like Amarillo, Texas; Greeley, Colo.; or Ogden, Utah were hospitalized at the time of death, compared to more than one-third of patients in the New York City borough of Manhattan.

“It is our hope that future work that we and others perform can address the cause of this variation, so that all patients can experience the best care based on their personal wishes,” Stevens said.