Physician Characteristic Strongest Predictor of Hospice Use Among Patients

A physician’s individual preference for referring patients to hospice care is the strongest predictor of whether or not a patient will enroll in hospice care. In other words, there was a strong connection between the proportion of patients a physician already had enrolled in hospice care and whether or not other patients would enroll in hospice, according to a study published in Health Affairs.

Researchers from Brigham and Women’s Hospital and Harvard University developed a method of measuring the relationship between physician characteristics and hospice enrollment among Medicare patients. Specifically, they focused on patients who had a diagnosis of poor-prognosis cancer and died during 2006 to 2011 and for whom palliative treatment and hospice were the standard of care.

"We found that the physician a patient sees is the single most important predictor we know of whether or not that patient enrolls in hospice care," Ziad Obermeyer, MD, a physician researcher in the Department of Emergency Medicine at Brigham and Women’s Hospital, assistant professor of emergency medicine at Harvard Medical School, and lead author of the paper, said in a statement. "This new information provides a clear policy target for improving and advancing the quality of care for patients at the end of their lives."

This predictor was stronger than other known predictors of hospice enrollment, such as patients’ medical comorbidity, age, race, and sex. The 198,948 patients analyzed were, on average, 78 years old, 88% white, and 52% male. However, the 66% who enrolled in hospice were more likely to be female, white, and live in areas with higher median incomes.

In addition, patients care for by medical oncologists or in not-for-profit hospitals were significantly more likely to enroll in hospice.

“These findings suggest that physician characteristics are among the strongest predictors of whether a patient receives hospice care—which mounting evidence indicates can improve care quality and reduce costs,” the authors wrote. “Interventions geared toward physicians, both by specialty and by previous history of patients’ hospice enrollment, may help optimize appropriate hospice use.”

After controlling for patient, hospital, and geographic factors that predict hospice enrollment, the researchers were able to calculate that patients who saw a physician in the top 10% of hospice use were 27% more likely to enroll in hospice care compared with patients seeing physicians in the bottom 10% of hospice use.

"As an emergency physician, I am often the first person to ask patients about what kind of care they want at the end of their life," Dr Obermeyer said. “In these situations, patients and their families often have only hours to make difficult and complex decisions. As physicians, we need to have these conversations earlier. We need to know what our patients really want at the end of their lives. We need to remove the barriers to having these discussions and give our patients the care they actually want."