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Regulating palliative care: the case of hospice.
- Source :
-
Journal of pain and symptom management [J Pain Symptom Manage] 2008 Aug; Vol. 36 (2), pp. 107-16. Date of Electronic Publication: 2008 Apr 18. - Publication Year :
- 2008
-
Abstract
- Palliative care services provided to patients and families vary substantially across hospices. Literature suggests regulation can act as a standardizing force in health care delivery. However, little is known about the effect of regulation on the delivery of palliative care in hospice and whether its effect differs for different types of hospice providers. We estimated the association between regulation, defined as Medicare hospice certification, and the delivery of palliative care in hospice using a nationally representative data set of 9,409 patients from 2,066 hospices surveyed in the National Home and Hospice Care Survey, 1992-2000. Using multivariable analysis, we found Medicare hospice certification was associated with a significantly broader range of services provided to patients (odds ratio [OR]=2.45; 95% confidence interval [CI]: 1.16, 5.17). This effect was significantly more pronounced (P-value for interaction=0.001) among for-profit hospices (OR=15.24; 95% CI: 4.06, 57.17) than among nonprofit hospices (OR=1.53; 95% CI: 0.75, 3.14). The effect of ownership on certification differences was most apparent for the provision of skilled nursing (prevalence difference in difference=52.4%), spiritual care (prevalence difference in difference=49.6%), and social services (prevalence difference in difference=48.1%). This study is the first to demonstrate the substantial association between the regulation of hospices and the provision of a multidisciplinary range of services to patients and families. It provides valuable insights regarding the potential role of regulation in standardizing the quality of palliative care across the increasingly diverse palliative care programs developing outside of hospice.
- Subjects :
- Humans
United States epidemiology
Certification statistics & numerical data
Hospice Care legislation & jurisprudence
Hospice Care statistics & numerical data
Pain epidemiology
Pain prevention & control
Palliative Care legislation & jurisprudence
Palliative Care statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1873-6513
- Volume :
- 36
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of pain and symptom management
- Publication Type :
- Academic Journal
- Accession number :
- 18395400
- Full Text :
- https://doi.org/10.1016/j.jpainsymman.2007.09.014