Journal of palliative medicine
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Comparative Study
Factors associated with the high prevalence of short hospice stays.
This study's goal was to gain an understanding of the factors associated with hospice stays of 7 days or less (i.e., short hospice stays), and to test the hypothesis that independent of changes in sociodemographics, diagnoses, and site-of-care, the likelihood of a short hospice stay increased over time. We examined hospice stays for 46655 nursing home and 80507 non-nursing home patients admitted between October 1994 and September 1999 to 21 hospices across 7 states, and owned by 1 provider. Logistic regression was used to determine the factors significantly associated with a higher probability of a short stay. ⋯ In (fiscal year) 1995, a nursing home resident admitted to hospice had a 26% probability (95% confidence interval [CI] 0.24, 0.28) of a less than 8-day stay and, in (fiscal year) 1999, the probability was 33% (95% CI 0.31, 0.34); a non-nursing home patient had a 32% probability in 1995 (95% CI 0.30, 0.34) and a 36% probability in 1999 (95% CI 0.34, 0.37). The probability of a short hospice stay was greater for patients with noncancer diagnoses, independent of year of hospice admission. In this paper we discuss the possible underlying reasons for the increased probability of short hospice stays and we speculate on what this increase may mean in terms of hospice's ability to provide high-quality end-of-life care.
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The concept of a good death is central to end-of-life care research. Despite its importance and the high interest in the topic, there are few measures currently available for use in clinical research. ⋯ The new Concept of a Good Death instrument appears to measure three distinct factors which people consider important to a Good Death. Ratings of the importance of these factors are reliable and valid. The instrument has the advantage of being a brief, self-report index for use in end-of-life care research.
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In 1999 the Wisconsin Coalition to Improve Palliative Care (WCIPC) conducted a palliative care needs assessment of health care institutions throughout the state of Wisconsin to document the current status of palliative care and identify institutional barriers and opportunities for improvement. ⋯ While health care institutions in Wisconsin provide a variety of palliative care services and offer educational programs that address areas of palliative care, institutional barriers do exist. This needs assessment provides valuable descriptive data that will guide efforts to improve palliative care throughout the state of Wisconsin.