Are Advance Directives Associated with Better Hospice Care?. Issue 6 (22nd May 2014)

• Record Type: Journal Article
• Authors: Ache, Kevin; Harrold, Joan; Harris, Pamela; Dougherty, Meredith; Casarett, David
• Is Part Of: Journal of the American Geriatrics Society. Volume 62:Issue 6(2014:Jun.)
• Page Start: 1091
• Page End: 1096
• Publication Date: 2014-05-22
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12851
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs12851-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12851-sec-0001" sec-type="section"> <title>Objectives</title> <p>To describe individuals with advance directives at the time of hospice enrollment and to determine whether they have patterns of care and outcomes that are different from those of individuals without advance directives.</p> </sec> <sec id="jgs12851-sec-0002" sec-type="section"> <title>Design</title> <p>Electronic health record–based retrospective cohort study with propensity score–adjusted analysis.</p> </sec> <sec id="jgs12851-sec-0003" sec-type="section"> <title>Setting</title> <p>Three hospice programs in the United States.</p> </sec> <sec id="jgs12851-sec-0004" sec-type="section"> <title>Participants</title> <p>Individuals admitted to hospice between January 1, 2008, and May 15, 2012 (N = 49, 370).</p> </sec> <sec id="jgs12851-sec-0005" sec-type="section"> <title>Measurements</title> <p>Timing of hospice enrollment before death, rates of voluntary withdrawal from hospice, and site of death.</p> </sec> <sec id="jgs12851-sec-0006" sec-type="section"> <title>Results</title> <p>Most participants (35, 968, 73%) had advance directives at the time of hospice enrollment. These participants were enrolled in hospice longer (median 29 vs 15 days) and had longer survival times before death (adjusted hazard ratio = 0.62; 95% confidence interval (CI) 0.58–0.66; <italic>P</italic> < .001). They were less likely to die within the first week after hospice enrollment (24.3% vs 33.2%; adjusted odds ratio (aOR) = 0.83, 95% CI = 0.78–0.88; <italic>P</italic> < .001). Participants with advance directives were less likely to leave hospice voluntarily (2.2% vs 3.4%; aOR = 0.82, 95% CI = 0.74–0.90; <italic>P</italic> = .003) and more likely to die at home or in a nursing home than in an inpatient unit (15.3% vs 25.8%; aOR = 0.82, 95% CI = 0.77–0.87; <italic>P</italic> < .001).</p> </sec> <sec id="jgs12851-sec-0007" sec-type="section"> <title>Conclusion</title> <p>Participants with advance directives were enrolled in hospice for a longer period of time before death than those without and were more likely to die in the setting of their choice.</p> </sec> </abstract>