When Black patients leave hospice care alive, they have a higher risk for being admitted to a hospital, according to a study published on May 16 in JAMA Network Open. 

About 15% of patients who enter hospice actually wind up being discharged from it before they die. That can happen for various reasons such as unplanned hospitalization, getting other treatment for a terminal condition, transferring to another hospice service, or if their condition improves. The transition to hospice can be hard, but moving to a different care setting can be challenging as well.

There’s not a lot of research on the factors that contribute to the risk of burdensome transitions out of hospice care. That’s why a team used Medicare data from more than 115,000 people between 2014 and 2019. Researchers examined the different types of burdensome transitions out of hospice care, including patients admitted to a hospital after leaving care and patients who died while hospitalized. The team wanted to understand what factors were linked to different transition outcomes. 

Investigators found that Black patients who had shorter hospice stays and received care from for-profit hospices had higher odds of challenging transitions after they were discharged from hospice.

“Hospice care teams may want to pay particular attention to the discharge planning needs of patients of racial and ethnic minority groups and patients with more complicated needs,” Elizabeth Luth, the lead author of the study and a faculty member of the Center for Healthy Aging Research at the Rutgers Institute for Health, Health Care Policy and Aging Research, said in a statement.

Data also showed that inpatient respite — services to give short-term relief for family caregivers — was associated with lower odds of hospitalization and hospice readmission. The same was true for general inpatient care, such as short-term hospital care in order to manage symptoms.

“Policymakers may want to consider making inpatient respite and general inpatient care more widely available and accessible to families with members in hospice with complex needs to support better outcomes if they are discharged,” Luth said.

See more McKnight’s coverage of the study.