Hospitalists More Likely than Specialists to Refer to Hospice

Hospitalized cancer patients have a greater likelihood of receiving a hospice referral from a hospitalist than other physicians, recent research has found.

Hospitalist-led services (HS) referred 11.8% of patients to inpatient hospice settings between July 26, 2021 and Jan. 31, 2022, a recent study found. This was a higher rate compared to the 5.8% of patients referred from traditional, oncologist-led services (TS) during the same time period, according to the study’s findings, published in the American Cancer Society Journals.

The findings illustrate how oncology hospitalists can help improve timely access to hospice in inpatient settings, according to the researchers. Cancer patients often spent less time in the hospital before a discharge into hospice as a result of oncology hospitalist services compared to those in oncology settings, according to Dr. Elizabeth Horn Prsic, one of the study’s researchers.

“What we saw was that our oncology hospital discharges to hospice doubled the percentage of patients in half the time compared to our oncology faculty,” Horn Prsic told Hospice News. “It wasn’t just double the rate, it was also in half the time. To me, that means that more patients and families were able to benefit from hospice hopefully over a longer period of time, which is very meaningful when their days are limited and they’re in this acute time of crisis.”

Horn Prsic is a medical oncologist and palliative care physician. She serves as the director of adult inpatient palliative care at the Yale School of Medicine in Connecticut. Horn Prsic is also the firm chief of medical oncology and education at the Smilow Cancer Hospital and Yale New Haven Hospital.

The research points to how hospice stays have the potential to lengthen as a result of earlier transitions from hospital-led services, according to Horn Prsic.

Cancer patients receiving these services had an average of 6.83 days in length of hospitalization stays prior to hospice admission, the study found. This was shorter than the average hospital stay of 16.29 days prior to a transition to hospice oncologist-led patients.

Regardless of setting, hospices can benefit from strengthening referral relationships across the board of inpatient settings, Horn Prsic said. Increasing these efforts can help provide greater pathways to hospice among patients with higher levels of needs, such as general inpatient care (GIP), she indicated.

“A hospice program can build a structure of support” Horn Prsic said. “It’s this double aim of having an excellent, well-oiled machine of care with those on the inpatient side and working very closely together. One of the challenges for hospitalists with the staffing shortages in other settings is getting more bedside assessments for GIP.”

Patients with a range of chronic conditions enter the health care sphere in a number of avenues, and it’s important to gain a grasp of where the largest gaps of need exist, including in different inpatient settings, she indicated. This begins with greater understanding around the types of patients seen in various settings, and also educating other health care providers about hospice, Horn Prsic stated.

“It’s aligning with the development of hospitalist programs, especially among patients that have serious illness, whether it’s advanced cancer, heart or renal failure, lung disease, neurologic issues or cognitive impairment,” Horn Prsic said. “It’s a need for understanding the acuity and unique issues in end-of-life for these various patient populations, and aligning with those clinicians there on the frontlines day in and day out. It’s having these conversations and knowing how things happen on the inpatient side to help them see how things can be a little bit different with referral management. They may not know hospice eligibility as intuitively.”