For-Profit Ownership and End-of-Life Care

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DESCRIPTION (provided by applicant): Hospice is an increasingly important aspect of care for patients with cancer and their families; currently, more than half of all patients dying from cancer use hospice. In the last decade, the hospice industry has experienced dramatic growth, in for-profit ownership. The number of for-profit hospices grew 300% while the number of nonprofit hospices grew only 43%. Despite this expansion, we know little about how for-profit ownership affects end-of-life care for patients with cancer and their families. To address this gap in knowledge, we will produce critical evidence about the impact of for-profit hospice ownership on cancer care. Our specific aims are: 1) to determine the association between hospice ownership type and claims-based quality indicators for patients dying from cancer, adjusted for patient and county-level features, and 2) to determine the association between hospice ownership type and additional quality indicators for patients dying from cancer that cannot be assessed with claims data and examine how these associations are modified by other organization-level features. For the first of these specific aims, we have created a unique dataset that has linked the Surveillance, Epidemiology, and End Results-Medicare database with the Medicare Provider of Services data and the Area Resource File and includes detailed clinical and utilization data for 88,293 patients with cancer. For the second specific aim, we will develop, pretest, and field a survey of 500 hospice organizations to evaluate organization-based quality indicators that have been recommended by RAND, the National Quality Forum, and the Institute of Medicine. The phenomenon of increasing for-profit ownership of hospice is dramatic, current, and has potentially far-reaching implications for patients with cancer and their families. At a time when government and employers are looking for private sector solutions to health care problems, it makes sense to ask what impact for-profit hospice ownership has on end-of-life care and to identify opportunities for improving cancer care. Relevance in lay language: We will generate knowledge about the influence of for-profit hospice ownership on the experiences of patients with cancer and their families.