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.
Bio
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.
Email: Lauren.Hunt@ucsf.edu