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Grant Details

Grant Number: 5R01CA116398-03 Interpret this number
Primary Investigator: Bradley, Elizabeth
Organization: Yale University
Project Title: For-Profit Ownership and End-of-Life Care
Fiscal Year: 2009
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Abstract

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.

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Publications

Hospice for nursing home residents: does ownership type matter?
Authors: Canavan ME, Aldridge Carlson MD, Sipsma HL, Bradley EH
Source: J Palliat Med, 2013 Oct;16(10), p. 1221-6.
EPub date: 2013 Jul 30.
PMID: 23895303
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Hospices' enrollment policies may contribute to underuse of hospice care in the United States.
Authors: Aldridge Carlson MD, Barry CL, Cherlin EJ, McCorkle R, Bradley EH
Source: Health Aff (Millwood), 2012 Dec;31(12), p. 2690-8.
PMID: 23213153
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US hospice industry experienced considerable turbulence from changes in ownership, growth, and shift to for-profit status.
Authors: Thompson JW, Carlson MD, Bradley EH
Source: Health Aff (Millwood), 2012 Jun;31(6), p. 1286-93.
PMID: 22665841
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Caring for grieving family members: results from a national hospice survey.
Authors: Barry CL, Carlson MD, Thompson JW, Schlesinger M, McCorkle R, Kasl SV, Bradley EH
Source: Med Care, 2012 Jul;50(7), p. 578-84.
PMID: 22310561
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Quality of palliative care at US hospices: results of a national survey.
Authors: Carlson MD, Barry C, Schlesinger M, McCorkle R, Morrison RS, Cherlin E, Herrin J, Thompson J, Twaddle ML, Bradley EH
Source: Med Care, 2011 Sep;49(9), p. 803-9.
PMID: 21685811
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The effect of comorbidity burden on health care utilization for patients with cancer using hospice.
Authors: Legler A, Bradley EH, Carlson MD
Source: J Palliat Med, 2011 Jun;14(6), p. 751-6.
EPub date: 2011 May 6.
PMID: 21548813
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Experiences of participants in a collaborative to develop performance measures for hospice care.
Authors: Schulman-Green D, Cherlin E, Pace KB, Hennessy M, Crocker PA, Bradley EH
Source: Jt Comm J Qual Patient Saf, 2011 Jan;37(1), p. 38-44.
PMID: 21306064
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Impact of hospice disenrollment on health care use and medicare expenditures for patients with cancer.
Authors: Carlson MD, Herrin J, Du Q, Epstein AJ, Barry CL, Morrison RS, Back AL, Bradley EH
Source: J Clin Oncol, 2010 Oct 1;28(28), p. 4371-5.
EPub date: 2010 Aug 30.
PMID: 20805463
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Benefits and challenges in use of a standardized symptom assessment instrument in hospice.
Authors: Schulman-Green D, Cherlin EJ, McCorkle R, Carlson MD, Pace KB, Neigh J, Hennessy M, Johnson-Hurzeler R, Bradley EH
Source: J Palliat Med, 2010 Feb;13(2), p. 155-9.
PMID: 19827961
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Hospice characteristics and the disenrollment of patients with cancer.
Authors: Carlson MD, Herrin J, Du Q, Epstein AJ, Cherlin E, Morrison RS, Bradley EH
Source: Health Serv Res, 2009 Dec;44(6), p. 2004-21.
EPub date: 2009 Jul 27.
PMID: 19656230
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