Annals of Long Term Care

Hospice Admission Practices: Where Does Hospice Fit in the Continuum of Care?
Karl A. Lorenz, MD, MSHS, Steven M. Asch, MD, MPH, Kenneth E. Rosenfeld, MD, Hui Liu, MS, and Susan L. Ettner, PhD

Objectives: To evaluate selected hospice admission practices that could represent barriers to hospice use and the association between these admission practices and organizational characteristics.

Design: From December 1999 to March 2000, hospices were surveyed about selected admission practices, and their responses were linked to the 1999 California Office of Statewide Health Planning and Development’s Home and Hospice Care Survey that describes organizational characteristics of California hospices.

Setting: California statewide.

Participants: One hundred of 149 (67%) operational licensed hospices.

Measurements: Whether hospices admit patients who lack a caregiver; would not forgo hospital admissions; or are receiving total parenteral nutrition (TPN), tube feedings, radiotherapy, chemotherapy, or transfusions.

Results: Sixty-three percent of hospices restricted admission on at least one criterion. A significant minority of hospices would not admit patients lacking a caregiver (26%). Patients unwilling to forgo hospitalization could not be admitted to 29% of hospices. Receipt of complex medical care, including TPN (38%), tube feedings (3%), transfusions (25%), radiotherapy (36%), and chemotherapy (48%), precluded admission. Larger program size was significantly associated with a lower likelihood of all admission practices except restricting the admission of patients receiving TPN or tube feedings. Hospice programs that were part of a hospice chain were less likely to restrict the admission of patients using TPN, radiotherapy, or chemotherapy than were freestanding programs.

Conclusion: Patients who are receiving complex palliative treatments could face barriers to hospice enrollment. Policy makers should consider the clinical capacity of hospice providers in efforts to improve access to palliative care and more closely incorporate palliation with other healthcare services. J Am Geriatr Soc 2004;52(5):725-730.

Physical Therapy and Mobility 2 and 6 Months After Hip Fracture
Joan D. Penrod, PhD, Kenneth S. Boockvar, MD, MS, Ann Litke, MA, Jay Magaziner, PhD, Edward L. HannanPhD, Ethan A. Halm, MD, MPH, Stacey B. Silberzweig, MS, RD, R. Sean Morrison, MD, Gretchen M. Orosz, MD, Kenneth J. Koval, MD, and Albert L. Siu, MD, MSPH

Objectives: To examine the relationship between early physical therapy (PT), later therapy, and mobility 2 and 6 months after hip fracture.

Design: Prospective, multisite observational study.

Setting: Four hospitals in the New York City area.

Participants: Four hundred forty-three hospitalized older patients discharged after surgery for hip fracture in 199798.

Measurements: Patient demographics, fracture type, comorbidities, dementia, number of new impairments at discharge, amount of PT between day of surgery and postoperative day (POD) 3, amount of therapy between POD4 and 8 weeks later, and prefracture, 2-, and 6-month mobility measured using the Functional Independence Measure.

Results: More PT immediately after hip fracture surgery was associated with significantly better locomotion 2 months later. Each additional session from the day of surgery through POD3 was associated with an increase of 0.4 points (P= .032) on the 14-point locomotion scale, but the positive relationship between early PT and mobility was attenuated by 6 months postfracture. There was no association between later therapy and 2- or 6-month mobility.

Conclusion: PT immediately after hip fracture surgery is beneficial. The effects of later therapy on mobility were difficult to assess because of limitations of the data. Well-designed randomized, controlled trials of the effect of varying schedules and amounts of therapy on functional status after hip fracture would be informative.