Evolution of Endoflife Care at United States Hospitals in the New Millennium

1New York Medical College, Valhalla, NY
2New York Downtown Hospital, New York, NY

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97574


The use of hospice care has increased in the United States over the past decade. However, data for hospitalizations preceding hospice remains sparse. The objective of this study is to examine the clinical and demographic characteristics of United States hospitalizations that result in hospice transfers, and to determine distinctive factors associated with discharges to hospice (DTH).


The National Inpatient Sample (NIS) databases for 2000–2009 were queried for hospitalizations which resulted in transfers to hospice and expiration in the hospital. Yearly totals, as well as demographic and clinical features were tabulated for DTH hospitalizations. These characteristics were also compared with hospitalizations that ended with expiration using multivariate regression.


The estimated number of DTH increased 15–fold from 27,912 to 420,882, while in hospital deaths decreased from 866,049 to 755,710 (Figure 1). The proportion of hospitalizations ending in DTH also increased from 0.08% to 1.07% (Table 1). Total hospital charges in the DTH group rose from 0.11% of total hospital charges in 2000 to 1.61% of total hospital charges in 2009. The median length of hospital stay decreased, while the median age, proportion of sepsis disease related groups (DRGs), and proportion of Medicare hospitalizations increased (Table 1). Lung, gastrointestinal, hepato–biliary, and brain cancer were consistently the most prevalent malignancy DRGs. However, the initial preponderance of hospitalizations with any cancer diagnosis was diminished by the end of the study. The adjusted odds ratio (95%CI) for the prediction of discharge to hospice (compared to hospital death) by any diagnosis of cancer decreased from 3.61 (3.52–3.71) to 2.02 (2.00–2.04). Female gender, age, and chronic obstructive pulmonary disease were predictors of DTH, while congestive heart failure was inversely associated.


Hospital discharges to hospice have increased over the past 10 years, with a concomitant shift in clinical and demographic characteristics. A growing trend toward offering and adopting hospice care upon discharge from US hospitals will likely impact health care finance and quality of care measures.

Figure 1Number of Patients Discharged to Hospice and Expired in Hospital by Year.

Table 1Characteristics of DTH from 2000–2009

To cite this abstract:

Scanlan B, Lin R, Levine R. Evolution of Endoflife Care at United States Hospitals in the New Millennium. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97574. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/evolution-of-endoflife-care-at-united-states-hospitals-in-the-new-millennium/. Accessed May 23, 2019.

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