Observational studyJournal of the American Geriatrics Society2022
A national study of disenrollment from hospice among people with dementia.
Observational study in Journal of the American Geriatrics Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Live Hospice Discharge of Individuals with Cognitive Disabilities: A Systematic Review.Journal of the American Medical Directors Association · 2025Pooled it
- National Trends in Types of Hospice Disenrollment Among Older Adults With Dementia, 2012-2019.Journal of the American Geriatrics Society · 2026Article
- "They're exhausted": Hospice Staff Views on Caring for Patients and Families Impacted By Dementia.Journal of pain and symptom management · 2026Article
- Article
- Top Ten Tips Palliative Care Clinicians Should Know About Hospice Live Discharge.Journal of palliative medicine · 2025Article
- Role of Attending Practice Variability in Prone Positioning Initiation: A Retrospective Cohort Study.CHEST critical care · 2025Article
- Hospice Use Among Medicare Beneficiaries With Parkinson Disease and Dementia With Lewy Bodies.JAMA network open · 2025Article
- Improving Policy and Practices of Hospice Live Discharge: A Historical Exploration of the Medicare Hospice Benefit.Journal of aging & social policy · 2025Article
- Article
- Naming racism as a root cause of inequities in palliative care research: a scoping review.BMC palliative care · 2024Article
- Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice.JAMA network open · 2024Article
- Health Care Costs Associated With Hospice Use For People With Dementia In The US.Health affairs (Project Hope) · 2023Article
- Hospice Quality, Race, and Disenrollment in Hospice Enrollees With Dementia.Journal of palliative medicine · 2023Article
- Functional and clinical needs of older hospice enrollees with coexisting dementia.Journal of the American Geriatrics Society · 2023Article
- Role of Home Health for Community-Dwelling Older Adults Near the End of Life: A Resource Beyond Hospice?Journal of palliative medicine · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
backgroundPeople with dementia (PWD) are at high risk for hospice disenrollment, yet little is known about patterns of disenrollment among the growing number of hospice enrollees with dementia.
designRetrospective, observational cohort study of 100% Medicare beneficiaries with dementia aged 65 and older enrolled in the Medicare Hospice Benefit between July 2012 and December 2017. Outcome measures included hospice-initiated disenrollment for patients whose rate of decline ceased to meet the Medicare hospice eligibility guideline of "expected death within 6 months" (extended prognosis) and patient-initiated disenrollment (revocation). Hospice, regional, and patient risk factors and variation were assessed with multilevel mixed-effects logistic regression models.
resultsAmong 867,695 hospice enrollees with dementia, 70,945 (8.2%) were disenrolled due to extended prognosis and 43,133 (5.0%) revoked within 1-year of their index admission. There was substantial variation in hospice provider disenrollment due to extended prognosis (10th-90th percentile 4.5%-14.6%, adjusted median odds ratio (MOR) 1.86, 95% confidence interval (CI) 1.82, 1.91) and revocation (10th-90th percentile 2.5%-10.1%, MOR 2.09, 95% CI 2.03, 2.14). Among hospital referral regions (HRR), there was more variation in revocation (10th-90th percentile 3.5%-7.6%, MOR 1.4, 95% CI 1.34, 1.47) than extended prognosis (10th-90th percentile 7.0%-9.5%, MOR 1.23, 95% CI 1.18, 1.27), with much higher revocation rates noted in HRRs located in the Southeast and Southern California. A number of patient and hospice characteristics were associated with higher odds of both types of disenrollment (younger age, female sex, minoritized race and ethnicity, Medicaid dual eligibility, Medicare Part C enrollment), while some were associated with revocation only (more comorbidities, newer, smaller, and for-profit hospices).
conclusionsIn this nationally representative study of hospice enrollees with dementia, hospice disenrollment varied by type of hospice, geographic region, and patient characteristics including age, sex, race, and ethnicity. These findings raise important questions about whether and how the Medicare Hospice Benefit could be adapted to reduce disparities and better support PWD.
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