The National Palliative Care Research Center

Curing suffering through palliative care research.


Lauren Hunt PhD, MSN

Assistant Professor

University of California, San Francisco

Grant Year
Grant Term
2 years
Grant Type
Kornfeld Scholars Program

Project Description
Potentially Burdensome Health Care Use Following Live Discharge from Hospice for Patients with Dementia

Almost 1 in 5 of the estimated annual 600,000 hospice recipients with dementia will have hospice services discontinued while still alive—a phenomenon referred to as “live discharge.” Without the support of hospice, burdensome transitions to the Emergency Department and hospital may increase. However, we know little about rates and predictors of burdensome transitions after live discharge for persons with dementia (PwD). Furthermore, we do not know how 2016 Medicare Hospice Payment Reform—which changed hospice reimbursement rates—will impact live discharge and burdensome transition rates. My long-term goal is to become a leader in dementia palliative care research and inform the evaluation and development of hospice and palliative care models and policies for PwD. I plan to leverage Medicare claims data to study the population of Fee-for-Service Medicare decedents with a principal or comorbid diagnosis of dementia who received hospice between 2013-2018 to: 1) Compare rates of potentially burdensome transitions in the last 30 days of life for decedents with dementia who experience a live discharge compared to decedents who stay continuously enrolled in hospice until death; 2) Identify patient characteristics, hospice provider characteristics, and contextual factors that predict potentially burdensome transitions for decedents with dementia who experience live discharge; 3) Compare rates of live discharge and burdensome transitions for decedents with dementia before (2013-2015) and after (2016-2018) Hospice Payment Reform. These research aims are closely aligned with my development aims to build knowledge and skills in: 1) Improving causal inference with observational data; 2) The clinical trajectory of dementia; and 3) Current issues in hospice and palliative care delivery and policy. Findings from this study will inform a K23 award to evaluate health care costs of live discharge and, ultimately, an R01 proposal to comprehensively evaluate hospice and palliative care access, costs, and quality for PwD.

Lauren Hunt, RN, PhD, FNP-BC is currently a VA Quality Scholars fellow at the San Francisco VA Health Care System.  She will be starting a position as an Assistant Professor in the UCSF Department of Physiological Nursing in Summer 2019 and has been selected as a UCSF Clinical and Translational Institute’s KL2 Scholar for 2019-2022.  Dr. Hunt received her MSN from Boston College and her PhD from UCSF School of Nursing.  Her research leverages existing datasets as a means to answer timely, high-impact questions focused on understanding the geriatric palliative care needs and experiences of older adults with dementia across care settings.