• Gulmeena Khan, Emmanuelle Belanger, and Joan Teno.
• Brown University (G.K., E.B., J.T.), Providence, RI 02912, USA. Electronic address: Gulmeena_khan@alumni.brown.edu.
• J Pain Symptom Manage. 2024 Dec 31.

ContextResearch shows hospice primary caregivers report better quality of care at Nonprofit (NP) than For-Profit (FP) hospices, but there is variation in quality across NP hospices.ObjectiveExamine bereaved caregiver reports of the quality as a factor of whether NP hospices are part of an integrated healthcare system that included an acute care hospital.MethodsCross-sectional study of NP Hospices used star ratings and adjusted hospice composite quality scores May 2023 publicly data reported on the Care Compare website. Using organizational website information, we compared hospices part of an integrated healthcare system with at least one acute care hospital to hospices without that affiliation. Primary outcomes were overall hospice adjusted CAHPs score and star ratings.ResultsNearly one-half (44.5%) of 645 NP hospices were part of integrated healthcare systems. Overall hospice CAHPs scores did not differ by organizational affiliation, mean score 82 [95% CI 82.8-83.6] for hospice part of integrated system vs 83.3 [95% CI 82.9-83.7] those without that affiliation), nor did mean star ratings (3.7 [ 95% CI 3.6-3.8] vs. 3.8[ 95% CI 3.7-3.8]) and CAHPs scores 3 points or more below the national average (29.5%[95% CI 24.3-35.1] vs 30.8%[ 95% CI 26.0-35.9]). State fixed-effects models showed a trend towards lower quality among hospice in integrated systems but did not reach conventional statistical significance.ConclusionCAHPs hospice scores did not differ if a hospice was part of integrated healthcare system or not. Further research is needed on variation in quality in NP hospices.Copyright © 2025 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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