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At least 19 recordsLinked to original sources
PubMed1999

History of the National Hospice Organization.

The National Hospice Organization grew out of efforts by the founders of the earliest hospice programs in the United States to protect their emotional investments in hospice care, to advocate for hospice interests in Congress and other public policy forums, to define standards for the fledgling movement, and to provide education on the nuts and bolts of running hospice programs for others who were interested in starting hospices in communities from coast to coast. Unlike the model of St. Christopher's Hospice in England, which began as a free-standing in-patient facility and later added home care services, most U.S. hospices started as home care-based programs, often largely manned by volunteers. Among the crucial issues that have dominated the work of NHO during its first 21 years were passage and maintenance of the Medicare hospice benefit, ideological battles over the hospice philosophy, and efforts to extend hospice care to other populations, such as people with AIDS.

Foundations↗
PubMed2004

Measuring hospice care: the National Hospice and Palliative Care Organization National Hospice Data Set.

Hospice has seen rapid growth in recent years, but there is a lack of consistency among hospices when it comes to compliance with standards of care. Consequently, hospices vary in performance and in services they provide. With state hospice organizations, the NHPCO developed a National Data Set (NDS) intended to understand demographics, practices, and outcomes; illustrate industry effectiveness; facilitate communication of industry legislative needs; and to support agency performance and improvement. Our paper describes development of the NDS and data that are being collected, and summarizes key findings from the 2000, 2001, and 2002 NDS. The data collection process, which began in 1999, has evolved substantially over a 4-year period to the point that we believe the 2002 NDS represents a well-designed core that will receive only minor modifications annually. This database will be invaluable for comparative audit, clinical practice and managing services because only that which is measured can be improved.

Data Collection↗
PubMed1998

An update on efforts by the hospice community and the National Hospice Organization to improve access to quality hospice care.

More than a year has passed since the Center to Improve Care of the Dying and the Corcoran Gallery of Art sponsored the symposium entitled: A Good Dying: Shaping Health Care for the Last Months of Life. Using the National Hospice Foundation sponsored exhibition, Hospice: A Photographic Inquiry, as a backdrop, the symposium included presentations on the current state of hospice care as well as the obstacles that limit access to hospice care. This article represents an update on many of the activities of the National Hospice Organization and the greater hospice community as we continue to improve access to quality hospice care.

Health Services Accessibility↗
PubMed1983

National hospice study analysis plan.

Since the founding of the first hospice in the United States in 1974, the number of health care organizations providing hospice services has grown rapidly. In 1978, the U.S. General Accounting Office identified 59 operational hospices [1]. A survey undertaken by the National Hospice Organization (NHO) in 1980 found 235 operational programs and many more actively planning to deliver services. By the summer of 1981, the Joint Commission on the Accreditation of Hospitals (JCAH), in studying the feasibility of a voluntary hospice accreditation program, had 650 responses to a national survey [2]. Finally, the 1981 NHO directory identifies 464 operational "provider programs" as well as 33 functioning state-level hospice organizations with an additional 353 programs in various stages of establishing hospice programs of care [3]. The growth of the movement and the public recognition it has received have catalyzed advocacy of Federal support for hospice services. In 1979, the Congress responded by mandating a study to delineate the implications of inclusion of hospice services in the Medicare program. The Health Care Financing Administration (HCFA) then selected 26 hospices (from an applicant pool of 233) to participate in a two-year experimental program. These demonstration sites receive reimbursement for services provided Medicare beneficiaries not otherwise available under current regulations. The special reimbursement provisions went into effect on October 1, 1980. (See Appendix A: Description of the Hospice Reimbursement Program.) In the spring of 1980, the Robert Wood Johnson Foundation and the John A. Hartford Foundation joined with the Health Care Financing Administration (HCFA) to solicit proposals for a national evaluation of hospice care as a basis for future Federal fiscal policy and legislation. Brown University was selected as the evaluation center by competitive process and the grant was awarded on September 30, 1980. The evaluation employs a quasi-experimental design in which the impact of hospice care (with and without reimbursement) on quality of life and costs are compared to non-hospice (conventional) terminal care. Eight hundred patients and families in 24 comparison sites located in three regional areas (Southern New England, Northern Midwest and Southern California) are expected to participate. Primary data collection began on August 1, 1981. Analyses of differential outcome are performed using standard linear multiple regression and logistic multiple regression with separate models for each comparison group. Effects are tested by separately estimating the specific response variable for the prototype (average) hospice patient for each model.

Costs and Cost Analysis↗
PubMed1999

Evaluation of prognostic criteria for determining hospice eligibility in patients with advanced lung, heart, or liver disease. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.

CONTEXT: Many individuals involved with care of the dying advocate expanding access to hospice care for persons with advanced lung, heart, or liver disease. However, to be eligible, these patients generally must have a prognosis for survival of less than 6 months. OBJECTIVE: To test the ability of currently available criteria to identify a population with a survival prognosis of 6 months or less among seriously ill hospitalized patients with 1 of 3 commonly fatal chronic diseases. DESIGN: Validation study using data from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) phase 1 (June 1989-June 1991) and phase 2 (January 1992-January 1994), with a 6-month follow-up. SETTING AND PATIENTS: Consecutive sample of 2607 seriously ill patients from 5 US medical centers who were hospitalized with chronic obstructive pulmonary disease, congestive heart failure, or end-stage liver disease, and who survived to hospital discharge. MAIN OUTCOME MEASURES: Descriptive and operating characteristics of 5 general and 2 disease-specific clinical criteria for identifying patients with a survival prognosis of 6 months or less, and 3 sets of combination criteria (broad, intermediate, and narrow inclusion) aimed at providing low, medium, and high thresholds for hospice eligibility based on National Hospice Organization guidelines. RESULTS: Seventy-five percent of the sample survived more than 6 months after hospital discharge; 44% expressed a preference for palliative care. Broad inclusion criteria identified 923 patients eligible for hospice care, of whom 70% survived longer than 6 months. Intermediate inclusion criteria identified 300 patients, of whom 65% survived longer than 6 months. Narrow inclusion criteria identified 19 patients, of whom 53% survived longer than 6 months. Sensitivities and specificities of the combination criteria were 41.7% and 66.7% (broad inclusion), 16.2% and 90.1 % (intermediate inclusion), and 1.4% and 99.5% (narrow inclusion), respectively. CONCLUSIONS: These data indicate that for seriously ill hospitalized patients with advanced chronic obstructive pulmonary disease, congestive heart failure, or end-stage liver disease, recommended clinical prediction criteria are not effective in identifying a population with a survival prognosis of 6 months or less.

Adult↗
PubMed2004

Barriers to hospice care and referrals: survey of physicians' knowledge, attitudes, and perceptions in a health maintenance organization.

INTRODUCTION: Many proponents of hospice care believe that this service is underutilized. OBJECTIVE: To determine physicians' perceptions of hospice utilization and of their own hospice referral pattern; their perceived and actual knowledge of appropriate hospice referral diagnoses; and perceived barriers to hospice referral. METHODS: Surveys for anonymous response were distributed to 125 physicians in 2 internal medicine departments of a large not-for-profit health maintenance organization (HMO). Of these 125 physicians, 89% responded, including 91 staff physicians and 20 residents. RESULTS: Of the 111 physician-respondents, 78% reported their belief that hospice care was underutilized; 84% were unable to identify appropriate hospice diagnoses; and 12% were aware of the "National Hospice Organization Medical Guidelines for Determining Prognosis in Selected Non-Cancer Diseases." Difficulty of predicting death to within 6 months was cited by 37% as the foremost barrier to hospice referral. In addition, 28% expressed concern that patients or families would interpret hospice referral as a cost saving measure; 11% of respondents had been accused of using hospice referral for this purpose. CONCLUSION: Our study-the first major survey of physician attitudes and practices regarding hospice utilization in an HMO setting-showed that barriers to hospice referral are similar to those in non-HMO settings; physicians have difficulty predicting life expectancy and lack knowledge of patient eligibility guidelines. Physician concern that patients or their family members would construe hospice referral as a cost-saving technique may be a barrier particularly troublesome in an HMO setting.

Adult↗
PubMed1997

Assisted suicide for the terminally ill: why we must have a choice.

As someone who believes in assisted suicide (AS) for terminally ill patients, I find the American Nurses Association and National Hospice Organization's official opposition a cause of profound concern. One of the arguments used by these organizations is that the lack of good palliative care is a major reason people request aid in dying. The assumption is that symptoms can be controlled adequately at all times. To me, such beliefs represent an ideology of a certain kind of death--a good death--espoused in such statements. This essay is an opportunity to express a different reality.

Attitude to Death↗
PubMed1997

Hospice and palliative care education in medical school: a module on the role of the physician in end-of-life care.

BACKGROUND: As a part of a program to integrate comprehensive palliative care education at the University of Maryland School of Medicine, a new teaching module was incorporated into the Introduction to Clinical Practice course for freshman medical students. METHODS: The module is entitled "The Role and Responsibility of the Physician in Palliative and End-of-life Care: the Inter-disciplinary Team Approach." The teaching objectives are: 1) describe the value of palliative and end-of-life care as a professional practice; 2) delineate the barriers to physician competence in end-of-life care; 3) describe the concept of hospice and the multidisciplinary approach to the care of the terminally ill; 4) List the fundamental areas of knowledge and skills required for a physician to be an effective member of the palliative care team. The format of the module is a 30-minute didactic/interactive overview of the teaching objectives, followed by a 30-minute videotape "Care Beyond Cure," produced by the National Hospice Organization. The class then breaks up into small groups to discuss, over a two-hour period, a hypothetical illustrative case. RESULTS AND CONCLUSIONS: The module was applied to the freshman medical student class in the 1995-1996 academic year. All freshmen were required to take it. Outcome evaluation utilized tools to assess attitude and cognitive domains. The attitude survey revealed that the majority of the students agreed that care of the dying could be a rewarding experience for the physician (72%) and that the case had helped them to understand the physician's role (93%). Overall, 82% wanted to learn more about the subject. Cognitive assessment tools indicated that the students satisfactorily understood the fundamental definitions of palliative care and hospice.

Attitude to Death↗
PubMed1999

Transforming end-of-life care for the 21st century: the hospice vision.

Hospice is recognized as the model for excellence in end-of-life care but its accessibility remains limited. A committee of the National Hospice Organization recently examined the barriers to hospice care and articulated a vision for quality end-of-life care for the 21st century. Its recommendations include public policy changes and other initiatives involving research, the education and practice of health professionals, the engagement of the public, and the operation of hospice programs.

Journal Article↗
PubMedDate not supplied

Facilitating communication and collaboration across the continuum: a transportable plan of care.

As the healthcare system becomes more complex and the need for communication and collaboration more critical, knowledge of hospice and palliative care, coupled with an easy-to-use tool that communicates a patient's wishes, becomes invaluable in preserving the dying patient's rights and wishes. Through this project, a stronger commitment and awareness of end-of-life issues and rights has been realized by those patients, families, and healthcare communities involved. The recipient of a National Hospice Organization Award of Excellence, the Plan of Care project is a model that can and should be adapted and incorporated into all healthcare settings to enhance continuity of care across settings and help to preserve the rights and wishes of all patients.

Communication↗
PubMed1997

Criteria for enrolling dementia patients in hospice.

OBJECTIVE: Because survival time varies greatly, it is difficult for dementia patients to meet a key criterion for eligibility for the Medicare hospice benefit: a 6-month survival time. We have developed criteria for the Medicare hospice benefit that include the characteristics of advanced dementia and related medical complications. The purpose of the study was to determine survival time among dementia patients who met these criteria. Additionally, because the National Hospice Organization (NHO) developed its own guidelines while the study was in progress, we retrospectively examined the application of these guidelines to our sample. DESIGN: Two cohorts of hospice patients were studied longitudinally, each for 2 years. SETTING: Nine Midwestern hospice programs. PARTICIPANTS: Forty-seven patients were enrolled in home hospice and institutional hospice settings. MEASUREMENTS: Survival time consisted of the number of days between enrollment in the hospice program and death or the end of the study. Other measures included Activities of Daily Living, ratings of Appetite, Nourishment, and Mobility, Functional Assessment Staging (FAST), a Medical Complications Checklist, and a care plan concerning the use of medications for acute illness. RESULTS: Our hospice enrollment criteria predicted a median survival time of 4 months and a mean survival time of 6.9 months; 38% of patients survived for more than 6 months. FAST scores and Mobility ratings were significantly related to survival time. However, 41% could not be scored on the FAST as their disease progression was not ordinal. Among patients who could be scored on the FAST and who had reached Stage Seven C, their mean survival time was 3.2 months compared with 18 months among those who could be scored and had not reached this stage and 8.6 months among patients whose disease progression was not ordinal, P < .001. When the palliative care plans were examined, less aggressive care plans resulted in shorter survival times, P < .01. CONCLUSION: Our hospice enrollment criteria identified a group with a median survival time of 4 months and a mean survival time of 6.9 months. Using NHO criteria relying on the FAST allows the identification of a subgroup with very high mortality and a short time until death. Although the FAST can identify a subgroup of appropriate candidates for hospice, sole reliance on this measure might decrease access to hospice care for many dementia patients.

Activities of Daily Living↗
PubMedDate not supplied

Criteria for enrolling dementia patients in hospice: a replication.

Because survival time varies greatly in dementia, it is difficult for dementia patients to meet a key criterion for the Medicare Hospice Benefit, a six-month survival time. In a previous study, the authors examined guidelines for admitting dementia patients to hospice; the National Hospice Organization (NHO) guidelines were found to work well in identifying appropriate candidates for hospice among dementia patients. This was especially true for those patients whose deficits had progressed in an ordinal fashion consistent with Functional Assessment Staging (FAST) and who had reached stage 7C. The purpose of this study was to examine the utility of the NHO guidelines in identifying dementia patients who are appropriate for hospice; the limitations of these guidelines regarding non-ordinal patients; and the importance of the actual care plans used--as opposed to our previous study, which only examined initial treatment plans. Forty-five dementia patients enrolled in Hospice of the Great Lakes in Illinois were studied longitudinally over two years; this included a follow-up period of at least six months for all patients. Measures included: survival time; FAST; a medical complications checklist, which consisted of common complications of end-stage dementia; and co-morbid medical conditions and aggressive care, which consisted of feeding tubes, antibiotics, and Foley catheters used during the course of the study. Patients who had reached Stage 7C at intake had a mean survival time of 4.1 months; and the majority (71 percent) died within six months. Non-ordinal patients lived significantly longer at a mean of 10.9 months (p < .01), and and the minority (30 percent) died within six months. Foley catheters decreased survival time; and the use of antibiotics did not make a difference. This study echoed our previous findings regarding the usefulness of NHO guidelines in identifying dementia patients with a survival time of six months or less, specifically those at stage 7C or greater. The findings also suggest that the nature of the palliative care plan influences survival time.

Aged↗
PubMed1999

Advanced Cancer and Comorbid Conditions: Prognosis and Treatment.

BACKGROUND: Nonmalignant comorbid medical conditions, such as heart failure and emphysema, may complicate cancer treatment. METHODS: Guidelines from the National Hospice Organization for cancer and selected nonmalignant diseases are outlined, and treatment principles for end-stage heart failure and emphysema are reviewed. RESULTS: Estimates by clinicians of survivability in advanced cancer and nonmalignant disease are important in order to allow patients and family members to begin realistic advance planning. As disease progresses through its end stages to death, optimal management may include both disease-modifying and symptom-relieving interventions. CONCLUSIONS: A well-managed end of life is an important therapeutic option in informed consent discussions with seriously ill patients and their families.

Journal Article↗
PubMed1982

A comparative study of hospice services in the United States.

In order to document the implementation of the hospice concept in the United States, 24 hospices, in operation at least one year and serving at least 100 patients, were selected from the National Hospice Organization roster to participate in a survey of organization, staffing, funding, services and population served. All of the hospices offered both home care and bereavement programs but only 41.7 per cent provided an inpatient program. Ten of the hospices were institutionally based, usually in a hospital. Inpatient services were associated with institutional affliations. The average profile of patients admitted to hospice was a 60-year-old White (89 per cent), female (54.3 per cent) cancer patient (94.5 per cent) whose spouse was primary care giver (63.8 per cent). Hospices provided a wide variety of both medical and social services provided by volunteers as well as paid staff. It appears that two divergent types of hospices are developing: 1) independent, heavily volunteer hospices with a variety of professional staff delivering a wide array of social/psychological services with unstable funding; and 2) institutionally based hospices providing both inpatient and home care, greater variety of medical/nursing services, less variety of social/psychological services, using fewer types of volunteers and paid staff, and not experiencing funding problems.

Female↗
PubMed1984

Occupational therapy in hospice care.

As hospice care becomes more integrated in the overall health care delivery system, the profession of occupational therapy needs to analyze further its potential within this unique system. This article briefly discusses the goals and philosophy of the hospice concept from the perspective of the National Hospice Organization. Occupational therapy intervention in terminal care is examined, with emphasis on locus of control and occupation as determinants in enhancing quality of life for the terminally ill in a nontraditional rehabilitative environment. A brief case study illustrates some of the general principles discussed throughout the article.

Aged↗