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Kidney Week

Abstract: FR-PO886

Concurrent Hospice in a Veterans Affairs Dialysis Unit: A Single-Center Experience

Session Information

  • Geriatric Nephrology
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1300 Geriatric Nephrology

Authors

  • Magliulo, Eric, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Samson, Kaeli, University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Khan, Saber M., Creighton University School of Medicine, Omaha, Nebraska, United States
  • Birch, Nathan C., University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Tendulkar, Ketki K., University of Nebraska Medical Center, Omaha, Nebraska, United States
Background

Patients with end stage kidney disease experience significant underutilization of hospice services. The Centers of Medicare and Medicare Services allows for enrollment in concurrent hospice and dialysis. We sought to share our experience with this program.

Methods

We analyzed all deaths among dialysis patients at our institution (n=49) between 2019 and 2022. Of these, 27 (55%) were enrolled in concurrent hospice. Data collected included: demographics, comorbidities, health care utilization, code status, and location of passing. Descriptive statistics were used for continuous data. Associations between variables of interest and concurrent hospice were assessed using χ2, Fisher’s exact, or Wilcoxon Rank Sum tests. All analyses were performed using SAS 9.4.

Results

Among patients receiving concurrent hospice services and hemodialysis, the median time on hospice was 26 days (IQR: 9.0, 62.0). There were no differences between the two cohorts for year of passing, age and common comorbid conditions. During the last 12 months of life, there were no differences in emergency department visits, hospitalizations, invasive procedures, or blood cultures drawn. A higher proportion of patients on concurrent hospice, had “do not resuscitate” orders at the time of passing (96.3% vs. 22.7%; p < 0.0001). Patients on hospice were less likely to pass in the hospital setting (22.2% vs. 63.6%, p = 0.004), but more likely to pass at home or in a skilled nursing facility (77.8% vs. 31.8%, p = 0.002).

Conclusion

Our data suggests that among the hemodialysis population, enrollment in concurrent hospice services was not associated with increased healthcare resource utilization. This information may help increase enrollment in hospice among dialysis patients and promote optimal end of life care.

Hospice Enrollment StatusEnrolledNot Enrolled p-value
N2722 
Age71 (66, 76)67 (54, 74)0.07
Days on dialysis1381 (488, 1813)935.5 (477, 1670)0.55
ED visits6.0 (2.0, 8.0)3.5 (1.0, 7.0)0.33
Hospitalizations2.0 (1.0, 4.0)2.0 (2.0, 4.0)0.96
IR visits1.0 (0.0, 3.0)1.0 (0.0, 2.0)0.53
Blood cultures 1.0 (0.0, 5.0)1.0 (0.0, 3.0)0.49
DNR at time of death26 (96.3%)5 (22.7%)< 0.0001
Passed in hospital setting6 (22.2%)14 (63.6%)0.0042
Passed at home or SNF21 (77.8%)7 (31.8%)0.0022