The use of physiologic measures and demographic variables to predict longevity among inpatient hospice applicants.

Abstract

Theadventof hospiceprogramsand theirfundingunderMedicarehasmade eligibility for a substantial insurance benefit contingentupon whether a patienthas a life ex5pectancynot excèedingsix months. The implicit assumptionis thatsuchapredictionis not only possiblebut reliableandaccurate. Severalstudies designedto determine costs of hospicecare provided data on the averagelongevity of hospiceapplicantswhich wereusedin theformationofthiseligibility requirement (SeeRosen for an overview of these federally-sponsoredresearch studies.)5TheNationalHospiceStudy, conductedby Brown University and sponsoredby the Departmentof Health, Education,and Welfare, studiedthe costsatfourteen hospitalbasedand elevennon-hospitalbased hospices.Findings concerninglongevity ofhospicepatientssuggestedan averagelengthofstayof 62 daysin the hospital-based programsand72daysin home-carehospiceprograms.3 Until recently, Medicare benefits coveredup to 210 days of hospice care.6On January1, 1989,Medicare lifted the duration of hospiceservice coveragerestrictionwhile keepingthe financial cap amount constant,the maximum amount reimbursedfor hospicecare. If aggregate,annual servicecostsexceedthe capstipulated by Medicare, reimbursementwill be limited to this amount.To be cost-effective, it is important for hospice programsto accuratelyand reliably predictthe life spanof applicants.A hospicemust limit the numberof patients acceptedwho require prolongedcare,thecostsof which,will cause the hospiceto exceedthe Medicareaggregatepaymentcap. A study undertakento determine how accurateexpertswere in predicting thelife spanof applicantsto aninpatient-hospicefoundthatevenin this severely ill population,prediction of life-spanwasfoundtobeimprecisefor any specificindividual andonly moderatelyaccuratein the aggregate.1 The investigatorscollecteddataon 48 objective measuresregardingapplicantdemographicsandhealthvariables.This studyinvestigateswhether theseobjectivevariables,either alone or in combination,could distinguish betweenapplicantswho are likely to die within either threeor six months andthosewhoarelikely tolive longer.