Characteristics of Hospice Care Discharges:

United States, 1993–94

by Barbara J. Haupt, D.V.M., Division of Health Care Statistics

Introduction

This report presents statistics from

the 1994 National Home and Hospice

Care Survey (NHHCS), a segment of

the long-term care component of the

National Health Care Survey (1). The

NHHCS, an annual survey operated by

the National Center for Health Statistics

(NHCS), collects data on the use of

hospices and home health care agencies

in the United States. Information is

collected about the agencies that provide

hospice and home health care services,

their current patients, and their

discharges.

During the year prior to the survey,

there were an estimated 5,600,200

discharges from 10,900 hospices and

home health care agencies in the United

States; 5,272,200 of the discharges were

from home health care and 328,000

were from hospice care (2). A report has

been published presenting characteristics

of current hospice care patients served

in 1994 (3). This report, focusing on

hospice care discharges, provides

statistics on the complete episode of

care of this relatively small but

important area of the health care

industry.

Hospice care services are provided

by both home health care agencies and

by hospices. These agencies are usually

defined in terms of the primary focus of

the type of care they provide. Home

health care is provided to individuals

and families in their home or place of

residence for promoting, maintaining, or

restoring health, or for maximizing the

level of independence while minimizing

the effects of disability and illness,

including terminal illness. Hospice care

is defined as a program of palliative and

supportive care services that provides

Abstract

Objective— This report presents data on hospice care discharges. Numbers and

percents of discharges are shown by selected characteristics of the agencies from

which the patients were discharged, by selected patient characteristics, by services

provided, by types of personnel that provided the services, and by diagnoses of

these discharged patients.

Methods—The data used for this report are from the National Center for Health

Statistics’ 1994 National Home and Hospice Care Survey. This is an annual survey

through which data are collected on the use of hospices and home health care

agencies in the United States.

Results—There were an estimated 328,000 discharges from hospice care from

1,300 hospices and home health agencies in 1993–94. Death was the reason for

discharge for 88 percent of the discharges. Fifty-two percent of the discharges were

for men, 73 percent were for patients 65 years of age and over, 79 percent were

white, 49 percent were married, and 30 percent were widowed. Eighty-three percent

of the discharged patients were living in a private or semiprivate residence during

their care and 95 percent had a primary caregiver. During the last time service was

provided prior to discharge, 67 percent received help from the agency with at least

one activity of daily living (ADL), 53 percent with at least one instrumental activity

of daily living (IADL), and 30 percent with walking. These discharges had an

average of 2.2 diagnoses at admission; 69 percent had a primary diagnosis of a

malignant neoplasm; and 8 percent had a primary diagnosis of heart disease.

Keywords: National Home and Hospice Care Survey v long-term care v functional

status v malignant neoplasms

Number 287 + April 25, 1997

From Vital and Health Statistics of the CENTERS FOR DISEASE CONTROLAND PREVENTION/National Center for Health Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

CENTERS FOR DISEASE CONTROL AND PREVENTION
physical, psychological, social, and

spiritual care for dying persons, their

families, and other loved ones (2).

Hospice care in the United States

began in the early 1970’s and relied

heavily on professional and lay

volunteers. The movement has since

grown into a more formal, regulated

industry. Reimbursement for hospice

care services is provided by many

insurance programs, including Medicare

and Medicaid. The goals of hospice care

are to provide a good quality of life for

the dying patient and to help the patient

and his/her family cope with the

approaching death in an appropriate

manner. Emphasis is on palliative care

of the patient, rather than on curing the

disease or extending life. Control of

pain—physical, mental, social, and

spiritual—is stressed. Although hospice

services are available in inpatient

settings, most of these services are

provided in the patient’s home or usual

place of residence (2–6).

Methods

Data collection for the 1994

NHHCS was conducted between

September and December 1994. Data

were collected on a sample of current

patients and of discharges from a

representative sample of hospices and

home health care agencies. Patient data

were obtained from the medical records

of the sampled patients and discharges.

A brief overview of the data collection

methods and estimation procedures for

the 1994 NHHCS is in the Technical

notes. More detailed information is

published in other reports (2,7,8).

Statistics presented in this report are

estimated numbers and percents of

hospice care discharges by various items

of interest. A limited amount of

information about the agencies that

provided the services is also given. For

this report, agencies that provided

hospice care services are limited to

those agencies with at least one

discharge from hospice care during a

designated month prior to the time of

the survey.

Agency characteristics examined

include ownership, Medicare and

Medicaid certification, affiliation,

location, and size. Ownership refers to

the type of organization that controlled

and operated the agency at the time of

the survey. Affiliation status is limited to

affiliation with a hospital or a group of

agencies (such as a chain). Not all

agencies are affiliated, and some may

have other types of affiliation that are

not included. Two types of location are

reported: geographic region and

metropolitan statistical area. Size was

determined from the total number of

both hospice and home health care

discharges that occurred during a

specified month during the 12 months

prior to the time of the survey. This

number was obtained from the list of

discharges that was used for sample

selection and that was constructed at the

time of the survey.

Patient information included in this

report consists of demographic

characteristics (sex, age, race, and

marital status), reason for discharge,

living arrangements, primary caregiver

status, and functional status. Information

on functional status includes use of

special aids, vision, hearing, and

continence status. Statistics are also

presented about the services provided to

the discharged patients (including

assistance with activities of daily living,

walking, and instrumental activities of

daily living) and types of personnel that

provided the services. Activities of daily

living include bathing, dressing, eating,

transferring from a bed or a chair, and

using the toilet room. Instrumental

activities of daily living include doing

light housework, managing money,

shopping for groceries or clothes, using

the telephone, preparing meals, and

taking medications. Finally, diagnoses at

admission and at discharge are

examined.

The tests of significance used to test

all comparisons mentioned in this report

are based on the Bonferroni multiple

comparisons using the z-test with an

overall 0.05 level of significance. Not

all differences were tested, so lack of

comment does not mean that the

difference was not statistically

significant. Estimates in this report have

been rounded to the nearest hundred.

Therefore, detailed figures may not add

to totals. Percents were calculated using

unrounded figures and may not agree

with computations made from the

rounded data.

Results

Agency characteristics

Table 1 shows the number and

percent of agencies that had hospice

care discharges according to agency

characteristics. The number and percent

of discharges from these agencies are

also shown. An estimated 1,300

hospices and home health care agencies

in the United States had 328,000

hospice care discharges during 1993–94.

The vast majority of the

facilities—1,100, or 84 percent—were

voluntary nonprofit agencies. Seventyfour percent were certified under

Medicare and 67 percent were certified

under Medicaid as hospices, while

42 percent and 43 percent were certified

under Medicare and Medicaid,

respectively, as home health agencies.

Four hundred of the agencies, or

36 percent, were operated by a hospital,

and 500, or 42 percent, were part of a

group or chain of agencies.

Thirty-five percent of the agencies

with hospice care discharges were in the

South, 26 percent were in the Midwest,

25 percent were in the Northeast, and

14 percent were in the West. Eight

hundred (61 percent) of the agencies

were located in a metropolitan statistical

area (MSA).

Most of these agencies were

relatively small. Almost half

(48 percent) had 15 or fewer discharges

from hospice or home health care during

a given month prior to the survey,

19 percent had 16–30 discharges, and

32 percent had more than 30 discharges.

The majority of the hospice care

discharges (285,300, or 87 percent) were

from voluntary nonprofit hospices and

home health agencies. Over 85 percent

were from an agency that was certified

under Medicare and/or Medicaid as a

hospice, a home health agency, or both.

Twenty-eight percent of the discharges

were from a hospital-affiliated agency

and 48 percent were from an agency that

was part of a group or chain of

agencies.

Of all the hospice care discharges,

34 percent were from agencies in the

2 Advance Data No. 287 + April 25, 1997
Northeast, 30 percent from agencies in

the South, 22 percent from agencies in

the Midwest, and 14 percent from

agencies in the West. Although

61 percent of the agencies were located

in an MSA, these agencies had

83 percent of the discharges.

Not surprisingly, most of the

discharges were from larger agencies.

The 600 agencies with 15 or fewer

monthly discharges (48 percent of the

agencies) had only 18 percent (59,100)

of the hospice care discharges. In

contrast, 67 percent (218,800) of the

hospice care discharges were from the

400 agencies (32 percent) that had more

than 30 home and hospice care

discharges during any given month.

Discharge characteristics

Table 2 shows the number and

percent of hospice care discharges by

selected demographic characteristics and

reason for discharge. Although a larger

percent of the discharges were male

(52 percent were for men compared with

48 percent for women), the difference is

not statistically significant. The majority

of the discharges—73 percent—were for

patients 65 years of age and over. The

percent of discharges for each age group

did not differ significantly between the

two sexes.

Seventy-nine percent of the

discharges were white and 8 percent

were black and other races. Race was

unknown for 13 percent of the

discharges. There was no significant

difference in the percent of discharges

by sex within each race category.

Just under half (49 percent) of the

discharges were married at the time of

discharge. Of those who were not

married, the majority (67 percent) were

widowed. The marital status of male

discharges, however, was quite different

than that of female discharges. Males

were more likely to be married at the

time of discharge and females were

more likely to be widowed.

The most common reason for

discharge was death of the patient

(88 percent of all discharges were

deceased). Four percent of the

discharges occurred because the patient

was admitted to an inpatient health care

facility—most often a hospital.

Most of the discharged hospice

patients—83 percent—were living in a

private or semiprivate residence during

their episode of care, and about

11 percent were residents of an inpatient

health facility (table 3). Of the

discharges for noninstitutionalized

patients, 80 percent lived with family

members, 10 percent lived alone, and

9 percent lived with nonfamily

members. Men were more likely to be

living in a private or semiprivate

residence than were women. Although a

larger percent of women than of men

were living in a health facility during

their episode of care, the difference was

not statistically significant. Of the

discharges for noninstitutionalized

patients, a larger percent of men than of

women lived with family members.

The majority of the discharged

patients had a primary caregiver, that is,

an individual or organization responsible

for providing personal care assistance,

companionship, and/or supervision of

the patient. In addition, most of the

discharged patients with a primary

caregiver lived with their caregiver. Men

were more likely than were women to

live with their caregiver. Although the

primary caregiver was most often a

relative, the type of relationship was

Table 1. Number and percent distribution of agencies with hospice care discharges and

hospice care discharges by selected agency characteristics: United States, 1993–94

Agency characteristic

Agencies Discharges

Number

Percent

distribution Number

Percent

distribution

All agencies .......................... 1,300 100.0 328,000 100.0

Ownership

Proprietary........................... *100 *9.4 33,300 10.2

Voluntary nonprofit ...................... 1,100 83.8 285,300 87.0

Government and other ................... * * *9,300 *2.8

Certification1

Medicare:

As hospice . . . . . . . . . . . . . . . . . . . . . . . . . 900 74.2 287,400 87.6

As home health agency . . . . . . . . . . . . . . . . . 500 41.9 180,300 55.0

Medicaid:

As hospice . . . . . . . . . . . . . . . . . . . . . . . . . 800 67.2 279,700 85.3

As home health agency . . . . . . . . . . . . . . . . . 500 43.4 181,300 55.3

Affiliation1

Operated by hospital . . . . . . . . . . . . . . . . . . . . 400 35.5 93,200 28.4

Part of a group . . . . . . . . . . . . . . . . . . . . . . . . 500 41.5 155,700 47.5

Geographic region

Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 24.8 109,800 33.5

Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 26.4 73,600 22.4

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400 34.8 97,900 29.8

West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 14.0 46,800 14.3

Location of agency

MSA2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800 61.0 272,200 83.0

Non-MSA2 ........................... *500 *39.0 55,800 17.0

Size of agency3

1–6 discharges ........................ *300 *23.0 16,300 5.0

7–15 discharges . . . . . . . . . . . . . . . . . . . . . . . 300 25.2 42,800 13.0

16–30 discharges . . . . . . . . . . . . . . . . . . . . . . 200 19.4 50,200 15.3

31–100 discharges. . . . . . . . . . . . . . . . . . . . . . 300 22.8 103,900 31.7

More than 100 discharges ................. *100 *9.6 114,900 35.0

* Figure does not meet standard of reliability or precision.

1Numbers may not add to total since not all agencies are certified or affiliated and an agency may have more than one type of

certification or affiliation.

2MSA is metropolitan statistical area.

3Size of agency is based on the total number of both hospice and home health care discharges for a specified month.

NOTES: Numbers may not add to totals because of rounding. Percents are based on the unrounded figures.

Advance Data No. 287 + April 25, 1997 3
different for the two sexes. Men were

more likely to have a spouse as their

primary caregiver, while women were

more likely to be cared for by a child or

a child-in-law.

The number and percent of hospice

care discharges by selected aids used the

last time service was provided are

shown in table 4. Ninety percent of the

discharged patients used at least one aid.

Over one-half (54 percent) were using a

hospital bed and 43 percent were using

something to help with mobility—most

often a wheelchair or a walker. Other

aids used included eye glasses

(37 percent), commode (31 percent),

supplemental oxygen (29 percent), and

dentures (20 percent).

Thirty percent of the hospice care

discharges had an ostomy or an

indwelling catheter the last time service

was provided prior to discharge

(table 4). Excluding these discharges,

27 percent had difficulty controlling their

bladder and 22 percent had difficulty

controlling their bowels.

Table 4 also shows that over

one-half of the discharged patients did

not have difficulty seeing or hearing

(with the use of an aid if applicable).

Seventeen percent had some vision

impairment and 15 percent had some

hearing impairment, even with the use

of aids. Note, however, that the vision

or hearing status was unknown for some

30 percent of the discharges.

Table 5 provides information on

agency assistance with activities of daily

living (ADL’s), instrumental activities of

daily living (IADL’s), and walking, by

sex and by whether the discharged

patient lived with his or her primary

caregiver. As stated previously, patient

information collected through the

NHHCS is obtained from the medical

records maintained by the agency.

However, it has been found that

functional problems are frequently

underreported in medical records (9).

Therefore, information on ADL’s and

IADL’s collected in the NHHCS is

limited to identifying whether agency

personnel provided help with each

specific activity, rather than whether the

patient needed help with the activity.

Hence, measures of ADL’s and IADL’s

obtained through the NHHCS serve

more as indicators of services provided

rather than as indicators of functional

status. To the extent that hospice care

patients receive help from other persons

(such as their primary caregiver,

members of their family, and friends),

their need for help with these activities

is underestimated by the NHHCS.

The last time service was provided

before discharge, 67 percent of all

discharges received agency help with at

least one ADL, 53 percent received help

with at least one IADL, and 30 percent

received help with walking. With respect

to specific ADL’s, agency help was

received most often with bathing or

showering (64 percent), dressing

(51 percent), and transferring in or out

of beds or chairs (42 percent). For

specific IADL’s, the most common

types of assistance included taking

medications (37 percent) and doing light

housework (29 percent). Although a

larger percent of men than of women

received help with each ADL, with

preparing meals, and with walking, the

differences are not statistically

significant.

Of the discharged patients who

lived with their primary caregiver during

their episode of care, a larger percent

received agency help with at least one

ADL or IADL—specifically, with

bathing or showering, dressing,

transferring in or out of beds or chairs,

and taking medications. The differences

were significant, however, only for help

with at least one ADL and for help with

bathing or showering.

Services and diagnoses

The number and percent of

discharges for whom a service was

Table 2. Number and percent distribution of hospice care discharges by selected patient

characteristics, according to sex: United States, 1993–94

Patient characteristic

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

All discharges ...................... 328,000 171,500 156,500 100.0 100.0 100.0

Age at admission1

Under 65 years ..................... 88,400 45,700 42,800 27.0 26.6 27.3

Under 45 years ................... 18,600 12,200 *6,400 5.7 7.1 *4.1

45–64 years ..................... 69,900 33,500 36,300 21.3 19.5 23.2

65 years and over ................... 239,100 125,800 113,300 72.9 73.4 72.4

65–69 years ..................... 38,000 24,400 13,600 11.6 14.2 8.7

70–74 years ..................... 53,200 32,400 20,800 16.2 18.9 13.3

75–79 years ..................... 50,700 23,900 26,800 15.5 13.9 17.1

80–84 years ..................... 40,700 19,200 21,500 12.4 11.2 13.8

85 years and over.................. 56,500 25,900 30,600 17.2 15.1 19.6

Race

White ........................... 260,400 142,500 117,900 79.4 83.1 75.3

Black and other2 .................... 25,600 12,700 12,900 7.8 7.4 8.3

Black .......................... 24,000 11,800 12,200 7.3 6.9 7.8

Unknown......................... 42,000 16,300 25,700 12.8 9.5 16.4

Marital status at discharge

Married .......................... 160,300 108,700 51,600 48.9 63.4 33.0

Not married3

....................... 145,600 58,100 87,500 44.4 33.9 55.9

Widowed ....................... 97,300 32,900 64,400 29.7 19.2 41.1

Unknown......................... *22,200 * *17,400 *6.8 * *11.1

Reason for discharge1

Deceased ........................ 288,000 150,600 137,400 87.8 87.8 87.8

Admitted to inpatient facility ............. 13,000 * *5,800 4.0 * *3.7

Admitted to hospital................. *10,200 * * *3.1 * *

Other reason for discharge.............. 26,300 *13,700 *12,600 8.0 *8.0 *8.1

* Figure does not meet standard of reliability or precision.

1Excludes unknown.

2Includes race other than white, black, or unknown.

3Includes separated.

NOTES: Numbers may not add to totals because of rounding. Percents are based on the unrounded figures.

4 Advance Data No. 287 + April 25, 1997
provided during the 30 days prior to

discharge are shown in table 6. Virtually

all of the discharges had received at

least one of the listed services within

that time period. Of these, the vast

majority (91 percent) received skilled

nursing services. Over one-half received

social services or personal care

(62 percent and 61 percent,

respectively), 41 percent received

spiritual care, and about a third received

medications (37 percent), volunteer

services (35 percent), counseling

(32 percent), or durable medical

equipment or supplies (30 percent). A

significantly larger percent of women

than of men received continuous home

care; other differences noted are not

statistically significant.

Table 6 also provides information

on the type of service provider seen

during the 30 days prior to discharge.

Again, virtually all of the discharges had

been seen by at least one type of

provider. The type of provider seen

reflects the services provided. The vast

majority of discharged patients

(92 percent) had been seen by a

registered nurse, 65 percent had been

seen by a social worker, 55 percent had

been seen by a home health aide,

33 percent had been seen by volunteers,

and 33 percent had been seen by a

chaplain.

The number and percent of primary

and all-listed diagnoses at admission and

at discharge are shown in tables 7 and 8.

There was an average of 2.2 diagnoses

per discharge at admission and 2.1

diagnoses at discharge. Overall, the

discharge diagnosis did not differ

significantly from the diagnosis at

admission for both the primary

diagnosis and the all-listed diagnoses. At

admission, most (69 percent) of the

hospice care discharges had a primary

diagnosis of malignant neoplasm, and

about 8 percent had a primary diagnosis

of heart disease. Fifty percent of the

all-listed diagnoses were for a malignant

neoplasm and about 9 percent were for

some form of heart disease.

Information on the most common

admission diagnoses for hospice care

discharges according to sex is shown in

tables 9–11. Over two-thirds of the

discharges—68 percent of the men and

70 percent of the women—had a

primary diagnosis of malignant

neoplasm; the comparable percents for

all-listed diagnoses are 50 percent for

both men and women.

The most common malignant

neoplasms at admission are shown in

table 10 for male discharges and table 11

for female discharges. For men, the

most common primary malignant

neoplasms involved the trachea,

bronchus, and lung; the prostate; and the

large intestine and rectum. Women most

often had a primary malignant neoplasm

of the large intestine and rectum; the

trachea, bronchus, and lung; or the

breast. When looking at all-listed

diagnoses, malignant neoplasms of the

brain and spinal cord, the liver and

intrahepatic bile ducts, and the bone also

frequently occurred.

Summary and discussion

This report presents data on

characteristics of discharges from

hospice care services during 1993–94.

Overall, there were 328,000 hospice

care discharges from 1,300 hospices and

home health care agencies in the United

States. Most of the discharges were

from voluntary nonprofit organizations

and from agencies that were Medicare

and/or Medicaid certified.

Nine out of 10 hospice care

discharges occurred because the patient

died. Fifty-two percent of the discharges

were male and 4 out of 5 were white

patients. Overall, almost three-fourths of

the discharged patients were 65 years of

age and over when they were admitted

to the agency; at the time of discharge,

about half were married, almost a third

were widowed, and 4 out of every 5

were living in a private or semiprivate

residence. Most of the discharges had a

Table 3. Number and percent distribution of hospice care discharges by residence,

primary caregiver status, and living arrangements during care, according to sex:

United States, 1993–94

Patient characteristic

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

All discharges ...................... 328,000 171,500 156,500 100.0 100.0 100.0

Residence during care1

Private or semiprivate residence2 .......... 271,000 148,700 122,300 82.6 86.7 78.2

Board and care or residential care facility ..... *17,500 * * *5.3 * *

Health facility (including mental health facility) . . 36,900 17,400 19,500 11.3 10.2 12.5

Primary caregiver status

Had no primary caregiver3 .............. 16,100 *5,700 *10,300 4.9 *3.4 *6.6

Had primary caregiver. . . . . . . . . . . . . . . . . 311,900 165,800 146,200 95.1 96.6 93.4

Living arrangements4

Noninstitutionalized patients5 ............ 291,100 154,100 137,000 100.0 100.0 100.0

Lived with family members .............. 231,700 133,100 98,600 79.6 86.4 72.0

Lived alone ....................... 30,200 *9,800 20,400 10.4 *6.3 14.9

Lived with only nonfamily members ........ 24,900 *9,500 *15,400 8.6 *6.1 *11.3

Patients with primary caregiver

Total with caregiver . . . . . . . . . . . . . . . . . . 311,900 165,800 146,200 100.0 100.0 100.0

Lived with primary caregiver ............. 241,100 144,100 97,000 77.3 86.9 66.4

Relationship of primary caregiver to patient1

Spouse .......................... 139,800 98,600 41,300 44.8 59.5 28.2

Child and/or child-in-law ............... 99,500 35,900 63,600 31.9 21.7 43.5

Other relative ...................... 43,000 18,900 24,100 13.8 11.4 16.5

Friend or neighbor ................... *7,200 *5,400 * *2.3 *3.2 *

* Figure does not meet standard of reliability or precision.

1Excludes other and unknown.

2Includes private residence, rented room, boarding house, and retirement home.

3Includes unknowns.

4Excludes those for whom living arrangements are unknown.

5Excludes those living in health facilities.

NOTES: Numbers may not add to totals because of rounding. Percents are based on the unrounded figures.

Advance Data No. 287 + April 25, 1997 5
primary caregiver. Of those with a

primary caregiver, most were related to

and lived with their caregiver.

Discharged men tended to be

married, living in a private or

semiprivate residence, and living with

family members. Women tended to be

widowed. Although most of the

discharged women also lived in a

private or semiprivate residence and

lived with family members, a larger

proportion of women than men lived in

an inpatient health facility or lived

alone.

Of the discharged patients with a

primary caregiver, men were more likely

to live with their caregiver than were

women. Consistent with the patterns of

marital status and living arrangements,

the primary caregiver of most of the

men was their spouse. The primary

caregiver of most of the women, on the

other hand, was another relative, most

often a child or child-in-law.

Two-thirds of all discharges

received help from the agency with at

least one ADL, over half received help

with at least one IADL, and 3 out of 10

received help with walking. A

significantly larger proportion of

discharged patients who lived with their

primary caregiver received agency help

with at least one of the five ADL’s

listed and with bathing or showering.

Because this help was received within

the 30 days prior to the patient’s

discharge (almost always due to their

death), these patients were probably

quite debilitated and required more care

than the primary caregiver was able to

provide alone. It is speculated that

patients who were not living with or had

no primary caregiver but who were also

very debilitated were already living in

or had been discharged to an inpatient

health facility (tables 2 and 3).

Regarding services provided, a

significantly larger percent of women

than of men received continuous home

care within the 30 days prior to their

discharge. Again, this is consistent with

the patterns of marital status, living

arrangements, and caretaker status of

women.

References

1. Institute of Medicine. Toward a

national health care survey, a data

system for the 21st century.

Washington: National Academy

Press. 1992.

2. Strahan G. An overview of home

health and hospice care patients:

1994 National Home and Hospice

Care Survey. Advance data from vital

and health statistics; no 274.

Hyattsville, Maryland: National

Center for Health Statistics. 1996.

3. Haupt BJ. Characteristics of patients

receiving hospice care services:

United States, 1994. Advance data

from vital and health statistics; no

282. Hyattsville, Maryland: National

Center for Health Statistics. 1997.

4. Berry ZS, Lynn JL. Hospice

medicine. JAMA. 270(2):221–3. July

14, 1993.

5. Rhymes J. Hospice care in America.

JAMA. 264(3):36–72. July 18, 1990.

6. Rhymes JA. Home hospice care.

Clinics in Geriatric Medicine

7(4):803–16. November 1991.

7. Haupt B. Development of the

National Home and Hospice Care

Survey. National Center for Health

Statistics. Vital Health Stat. 1(33).

1994.

8. Jones A and Strahan G. The National

Home and Hospice Care Survey:

1994 annual summary. National

Table 4. Number and percent distribution of hospice care discharges by type of aids used

and functional status the last time service was provided, according to sex: United States,

1993–94

Patient characteristic

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

Total.......................... 328,000 171,500 156,500 100.0 100.0 100.0

Special aids

Discharges with at least one special aid1,2 . . 293,900 152,700 141,200 89.6 89.1 90.2

Aids used:

Hospital bed..................... 175,800 91,100 84,700 53.6 53.1 54.1

Mobility aids1 .................... 140,000 76,400 63,600 42.7 44.5 40.6

Wheelchair .................... 96,100 46,500 49,700 29.3 27.1 31.7

Walker ....................... 54,200 33,500 20,800 16.5 19.5 13.3

Crutches, cane.................. 25,500 19,700 *5,800 7.8 11.5 *3.7

Eye glasses ..................... 122,600 68,700 54,000 37.4 40.0 34.5

Commode ...................... 100,400 50,900 49,500 30.6 29.7 31.6

Oxygen........................ 94,000 48,600 45,400 28.7 28.3 29.0

Dentures ....................... 64,400 30,500 33,800 19.6 17.8 21.6

Shower chair .................... 27,300 17,600 9,700 8.3 10.3 6.2

Hearing aid ..................... *20,900 *7,500 *13,400 *6.4 *4.4 *8.5

Transfer equipment ................ *12,500 *9,100 *3,400 *3.8 *5.3 *2.2

All other aids .................... 75,000 38,300 36,700 22.9 22.3 23.4

Had ostomy or indwelling catheter ....... 98,000 52,900 45,100 29.9 30.9 28.8

Continence3

Difficulty controlling bladder ........... 88,400 43,500 44,900 27.0 25.4 28.7

Difficulty controlling bowels............ 73,100 34,600 38,500 22.3 20.2 24.6

Vision

Not impaired .................... 166,500 84,800 81,700 50.8 49.4 52.2

Impaired ....................... 56,200 31,800 24,400 17.1 18.6 15.6

Unknown4 ...................... 105,300 54,900 50,400 32.1 32.0 32.2

Hearing

Not impaired .................... 182,300 94,300 88,000 55.6 55.0 56.2

Impaired ....................... 48,300 28,200 20,100 14.7 16.4 12.9

Unknown4 ...................... 97,400 49,000 48,400 29.7 28.6 30.9

* Figure does not meet standard of reliability or precision.

1Numbers may add to more than total since more than one type of aid may have been used.

2Excludes unknowns.

3Excludes those with an ostomy or indwelling catheter.

4Includes those for whom status could not be determined (e.g., comatose patients, infants).

NOTES: Numbers may not add to totals because of rounding. Percents are based on the unrounded figures.

6 Advance Data No. 287 + April 25, 1997
Center for Health Statistics. Vital

Health Stat. 13(126). 1997.

9. Burns RB, Moskowitz MA, Ash A

and others. Self-report versus

medical record functional status,

medical care 30(5) Supp.: MS85-95.

May 1992.

10. Delfosse R. Hospice and home health

agency characteristics: United States,

1991. National Center for Health

Statistics. Vital Health Stat. 13(120).

1995.

11. National Center for Health Statistics.

Development and maintenance of a

national inventory of hospitals and

institutions. National Center for

Health Statistics. Vital Health Stat.

1(3). 1965.

12. Public Health Service and Health

Care Financing Administration.

International Classification of

Diseases, 9th Revision, Clinical

Modification, 4th ed. Washington:

Public Health Service. 1991.

13. Hoffman K. Specification of

estimators for NHHCS. Unpublished

memo. 1992.

14. Shah BV, Barnwell BG, Hunt PN,

and La Vange LM. SUDAAN User’s

Manual, Release 5.50. Research

Triangle Institute, Research Triangle

Park, NC. 1991.

Table 5. Number and percent distribution of hospice care discharges who received help

from the agency with activities of daily living, instrumental activities of daily living, and

walking the last time service was provided, according to sex: United States, 1993–94

ADL’s and IADL’s

All

discharges

Sex

Lived with

primary caregiver

Male Female Yes No1

Number

All discharges ..................... 328,000 171,500 156,500 241,100 86,900

Received help from agency with ADL’s

Received help with at least one ADL....... 219,700 121,100 98,600 170,900 48,800

ADL’s:

Bathing or showering . . . . . . . . . . . . . . . . 211,400 117,900 93,600 164,300 47,200

Dressing ........................ 165,800 92,200 73,600 127,400 38,400

Eating.......................... 90,100 47,800 42,400 61,000 29,100

Transferring in or out of beds or chairs ..... 137,200 72,500 64,700 106,200 31,000

Using the toilet room ................ 104,000 56,500 47,500 76,500 27,500

Received help from agency with IADL’s

Received help with at least one IADL ...... 172,100 87,100 85,100 130,000 42,100

IADL’s:

Doing light housework................ 96,300 46,900 49,400 71,700 24,600

Managing money ................... *5,000 * * * *

Shopping for groceries or clothes......... 24,700 *12,800 *12,000 14,000 *10,700

Using the telephone ................. *14,800 *6,500 * *4,600 *

Preparing meals ................... 52,300 28,800 23,400 32,400 19,900

Taking medications.................. 119,700 59,400 60,300 94,500 25,300

Received help from the agency with walking . . 97,000 54,800 42,300 70,500 26,500

Percent distribution

All discharges ..................... 100.0 100.0 100.0 100.0 100.0

Received help from agency with ADL’s

Received help with at least one ADL....... 67.0 70.6 63.0 70.9 56.2

ADL’s:

Bathing or showering ................ 64.5 68.7 59.8 68.1 54.3

Dressing ........................ 50.6 53.8 47.1 52.8 44.2

Eating.......................... 27.5 27.9 27.1 25.3 33.5

Transferring in or out of beds or chairs ..... 41.8 42.3 41.3 44.0 35.7

Using the toilet room ................ 31.7 32.9 30.3 31.7 31.6

Received help from agency with IADL’s

Received help with at least one IADL ...... 52.5 50.8 54.3 53.9 48.5

IADL’s:

Doing light housework................ 29.4 27.3 31.6 29.7 28.3

Managing money ................... *1.5 * * * *

Shopping for groceries or clothes. . . . . . . . . 7.5 *7.4 *7.6 5.8 *12.4

Using the telephone ................. *4.5 *3.8 * *1.9 *

Preparing meals ................... 15.9 16.8 15.0 13.4 22.9

Taking medications.................. 36.5 34.6 38.5 39.2 29.1

Received help from the agency with walking . . 29.6 31.9 27.0 29.2 30.5

* Figure does not meet standard of reliability or precision.

1Includes unknowns and discharges with no primary caregiver.

NOTES: Numbers may add to more than totals because help may have been received with more than one type of ADL or IADL.

ADL is activities of daily living and IADL is instrumental activities of daily living. Percents are based on the unrounded figures.

Advance Data No. 287 + April 25, 1997 7
Table 6. Number and percent distribution of hospice care discharges by services received and type of provider seen during the 30 days

prior to discharge, according to sex: United States, 1993–94

Patient characteristic

Both

sexes Male Female

Both

sexes Male Female

Number Percent distribution

All discharges ....................................... 328,000 171,500 156,500 100.0 100.0 100.0

Services received1

Received at least one service during the 30 days prior to discharge ..... 317,400 169,800 147,700 96.8 99.0 94.4

Discharges with at least one service2 ........................ 317,400 169,800 147,700 100.0 100.0 100.0

Skilled nursing services ................................. 290,100 157,100 133,100 91.4 92.5 90.1

Social services ...................................... 195,700 106,700 89,000 61.6 62.8 60.3

Personal care ....................................... 194,300 103,400 90,900 61.2 60.9 61.6

Spiritual care ....................................... 128,700 65,700 62,900 40.5 38.7 42.6

Medications ........................................ 117,000 60,000 57,000 36.9 35.3 38.6

Volunteer services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111,400 55,900 55,500 35.1 32.9 37.6

Counseling......................................... 101,300 57,300 43,900 31.9 33.8 29.7

Durable medical equipment and medical supplies................. 95,600 47,300 48,300 30.1 27.9 32.7

Physician services .................................... 56,000 33,100 23,000 17.7 19.5 15.6

Homemaker/Companion services ........................... 54,700 35,200 19,500 17.2 20.7 13.2

Dietary and nutritional services ............................ 32,600 *25,400 *7,200 10.3 15.0 *4.9

Referral services ..................................... 30,600 17,100 *13,400 9.6 10.1 *9.1

High tech care including enterostomal therapy................... *25,900 *18,600 *7,400 *8.2 *10.9 *5.0

Continuous home care ................................. 24,200 7,900 16,300 7.6 4.6 11.1

Inpatient respite care .................................. *22,100 *12,400 *9,700 *6.9 *7.3 *6.6

Oral hygiene/Prevention services ........................... 16,400 *11,600 *4,600 5.2 *6.8 *3.3

All other services ..................................... 26,500 14,500 12,000 8.4 8.5 8.1

Service provider1

At least one provider seen during the 30 days prior to discharge ....... 316,700 169,300 147,300 96.5 98.7 94.1

Discharges with at least one provider2........................ 316,700 169,300 147,300 100.0 100.0 100.0

Registered nurses .................................... 290,200 153,900 136,300 91.6 90.9 92.5

Social workers ...................................... 205,900 113,900 92,000 65.0 67.3 62.4

Home health aides .................................... 173,400 92,200 81,200 54.8 54.4 55.1

Volunteers ......................................... 104,800 50,600 54,200 33.1 29.9 36.8

Chaplain .......................................... 102,800 51,000 51,700 32.5 30.1 35.1

Physicians ......................................... 45,100 27,500 17,600 14.2 16.3 11.9

Nursing aides and attendants ............................. 44,300 27,800 16,500 14.0 16.4 11.2

Licensed practical or vocational nurses ....................... 34,800 19,000 15,800 11.0 11.2 10.7

Homemakers/Personal caretakers .......................... 16,700 *8,600 *8,100 5.3 *5.1 *5.5

All other providers .................................... 38,600 24,200 14,500 12.2 14.3 9.8

* Figure does not meet standard of reliability or precision.

1Numbers may add to more than total since more than one service may have been received or more than one provider may have been seen.

2Excludes unknowns.

NOTES: Numbers may add to more than totals because of rounding. Percents are based on the unrounded figures.

8 Advance Data No. 287 + April 25, 1997
Table 7. Number of hospice care discharges by diagnostic category of primary and all-listed diagnoses at admission and at discharge:

United States, 1993–94

Diagnostic category and ICD–9–CM code1

Primary diagnosis All-listed diagnoses

At

admission

At

discharge

At

admission

At

discharge

All diagnoses .................................................... 328,000 328,000 708,000 695,500

Infectious and parasitic diseases ................................... 001–139 9,900 9,500 14,700 14,300

Acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) 042–044 8,300 8,300 10,900 10,700

Neoplasms................................................. 140–239 232,300 226,800 359,200 352,600

Malignant neoplasms ................................... 140–208,230–234 226,300 220,900 351,200 344,600

Malignant neoplasm of large intestine and rectum ................... 153–154,197.5 37,300 35,800 40,700 39,100

Malignant neoplasm of liver and intrahepatic bile ducts ................... 155,197.7 *7,800 *7,800 31,700 30,700

Malignant neoplasm of pancreas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 *14,100 *13,600 *15,200 *14,700

Malignant neoplasm of trachea, bronchus, and lung ................ 162,197.0,197.3 45,500 46,100 59,500 58,600

Malignant neoplasm of bone ................................... 170,198.5 * * 23,700 23,500

Malignant neoplasm of breast............................... 174–175,198.81 17,000 16,600 17,900 17,400

Malignant neoplasm of female genital organs ...................... 179–184,198.6 *7,800 *7,800 8,300 8,300

Malignant neoplasm of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 17,100 16,900 18,300 19,500

Malignant neoplasm of brain and spinal cord ..................... 191,192.2,198.3 *7,600 *7,500 21,900 21,300

Malignant neoplasm of lymphatic and hematopoietic tissue ................. 200–208 14,600 14,300 18,000 17,700

Malignant neoplasm of other specified sites ...... 140–152,156,158–161,163–165,171–173,

176,186–190, 192.0–192.1,192.3–195,197.1–197.2,197.4,

197.6,197.8,198.0–198.2,198.4,198.7,198.82–198.89,230–234 43,200 43,000 60,000 59,900

Malignant neoplasm, disseminated or without specification of site . . . . . . . . . . . . . . . . 199 11,700 11,400 36,000 36,900

Endocrine, nutritional, and metabolic diseases and immunity disorders............ 240–279 * * 38,700 38,600

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 * * 17,200 16,700

Mental disorders ............................................. 290–319 * * 8,100 7,600

Diseases of the nervous system and sense organs....................... 320–389 *8,300 *8,300 27,300 26,400

Alzheimer’s disease............................................ 331.0 * * *4,800 *4,700

Other hereditary and degenerative diseases of the central nervous system.... 330,331.1–337 * * *6,200 *6,000

Diseases of the circulatory system .................................. 390–459 36,000 36,100 104,000 100,600

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401 * * 17,300 *17,800

Heart disease ..................... 391–392.0,393–398,402,404,410–416,420–429 25,800 25,400 63,300 59,300

Ischemic heart disease ...................................... 410–414 * * *11,200 *9,300

Congestive heart failure ........................................ 428.0 *10,800 *10,200 22,800 21,100

Cerebrovascular disease....................................... 430–438 *7,400 *7,500 16,900 16,800

Diseases of the respiratory system ................................. 460–519 7,200 7,300 35,600 34,700

Chronic obstructive pulmonary disease and allied conditions ................ 490–496 *6,000 *5,900 19,300 18,400

Diseases of the digestive system ................................... 520–579 * * *24,700 *24,700

Nonalcholic disorders of the liver and biliary tract ................... 570,571.4–576 * * *14,400 *14,800

Diseases of the genitourinary system ................................ 580–629 *10,600 *10,700 *14,900 *14,900

Renal failure .............................................. 584–586 *10,500 *10,600 *12,600 *12,700

Symptoms, signs, and ill-defined conditions ............................ 780–799 * * 26,700 27,800

Supplementary classifications .................................... V01—V82 * * *20,500 *18,600

Posthospital aftercare ...................... V42–V46,V52,V53.3–V53.7,V54–V58 * * *15,300 *14,900

All other diagnoses ................................................ * * 33,700 34,700

No or unknown diagnosis............................................. * *6,600 . . . . . .

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (12).

NOTE: Numbers may not add to totals because of rounding.

Advance Data No. 287 + April 25, 1997 9
Table 8. Percent distribution of hospice care discharges by diagnostic category of primary and all-listed diagnoses at admission and at

discharge: United States, 1993–94

Diagnostic category and ICD–9–CM code1

Primary diagnosis All-listed diagnoses

At

admission

At

discharge

At

admission

At

discharge

All diagnoses .................................................... 100.0 100.0 100.0 100.0

Infectious and parasitic diseases ................................... 001–139 3.0 2.9 2.1 2.1

Acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) 042–044 2.5 2.5 1.5 1.5

Neoplasms................................................. 140–239 70.8 69.2 50.7 50.7

Malignant neoplasms ................................... 140–208,230–234 69.0 67.3 49.6 49.5

Malignant neoplasm of large intestine and rectum ................... 153–154,197.5 11.4 10.9 5.7 5.6

Malignant neoplasm of liver and intrahepatic bile ducts ................... 155,197.7 *2.4 *2.4 4.5 4.4

Malignant neoplasm of pancreas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 *4.3 *4.1 *2.1 *2.1

Malignant neoplasm of trachea, bronchus, and lung ................. 162,197.0,197.3 13.9 14.0 8.4 8.0

Malignant neoplasm of bone ................................... 170,198.5 * * 3.4 3.4

Malignant neoplasm of breast............................... 174–175,198.81 5.2 5.0 2.5 2.5

Malignant neoplasm of female genital organs ...................... 179–184,198.6 *2.4 *2.4 1.2 1.2

Malignant neoplasm of prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 5.2 5.2 2.6 2.8

Malignant neoplasm of brain and spinal cord ..................... 191,192.2,198.3 *2.3 *2.3 3.1 3.1

Malignant neoplasm of lymphatic and hematopoietic tissue ................. 200–208 4.4 4.3 2.5 2.5

Malignant neoplasm of other specified sites ...... 140–152,156,158–161,163–165,171–173,

176,186–190,192.0–192.1,192.3–195,197.1–197.2,

197.4,197.6,197.8,198.0–198.2,198.4,198.7,198.82–198.89,230–234 13.2 13.1 8.5 8.6

Malignant neoplasm, disseminated or without specification of site . . . . . . . . . . . . . . . . 199 3.6 3.5 5.1 5.3

Endocrine, nutritional, and metabolic diseases and immunity disorders............ 240–279 * * 5.5 5.5

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 * * 2.4 2.4

Mental disorders ............................................. 290–319 * * 1.1 1.1

Diseases of the nervous system and sense organs........................ 320–389 *2.5 *2.5 3.9 3.8

Alzheimer’s disease............................................ 331.0 * * *0.7 *0.7

Other hereditary and degenerative diseases of the central nervous system.... 330,331.1–337 * * *0.9 *0.9

Diseases of the circulatory system .................................. 390–459 11.0 11.0 14.7 14.5

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401 * * 2.4 *2.6

Heart disease ..................... 391–392.0,393–398,402,404,410–416,420–429 7.9 7.8 8.9 8.5

Ischemic heart disease ...................................... 410–414 * * *1.6 *1.3

Congestive heart failure ........................................ 428.0 *3.3 *3.1 3.2 3.0

Cerebrovascular disease....................................... 430–438 *2.3 *2.3 2.4 2.4

Diseases of the respiratory system .................................. 460–519 2.2 2.2 5.0 5.0

Chronic obstructive pulmonary disease and allied conditions ................ 490–496 *1.8 *1.8 2.7 2.6

Diseases of the digestive system ................................... 520–579 * * *3.5 *3.6

Nonalcholic disorders of the liver and biliary tract ................... 570,571.4–576 * * *2.0 *2.1

Diseases of the genitourinary system ................................ 580–629 *3.2 *3.3 *2.1 *2.1

Renal failure .............................................. 584–586 *3.2 *3.2 *1.8 *1.8

Symptoms, signs, and ill-defined conditions ............................ 780–799 * * 3.8 4.0

Supplementary classifications .....................................V01–V82 * * *2.9 *2.7

Posthospital aftercare ...................... V42–V46,V52,V53.3–V53.7,V54–V58 * * *2.2 *2.1

All other diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * * 4.8 5.1

No or unknown diagnosis............................................. * *2.0 . . . . . .

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (12).

NOTES: Numbers may not add to totals because of rounding. Percents are based on unrounded numbers.

10 Advance Data No. 287 + April 25, 1997
Table 9. Number and percent distribution of hospice care discharges by diagnostic category of primary and all-listed diagnoses at

admission, according to sex: United States, 1994

Diagnostic category and ICD–9–CM code1

Primary diagnosis All-listed diagnoses

Both

sexes Male Female

Both

sexes Male Female

Number of diagnoses

All diagnoses ...................................................... 328,000 171,500 156,500 708,000 361,000 347,000

Infectious and parasitic diseases .................................... 001–139 9,900 8,400 * 14,700 12,500 *

Acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) . 042–044 8,300 7,500 * 10,900 9,700 *

Neoplasms.................................................. 140–239 232,300 119,200 113,100 359,200 184,000 175,200

Malignant neoplasms .................................... 140–208,230–234 226,300 116,200 110,100 351,200 179,100 172,100

Endocrine, nutritional, and metabolic diseases and immunity disorders............. 240–279 * * * 38,700 12,900 *25,800

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 * * * 17,200 *7,100 *10,100

Diseases of the circulatory system ................................... 390–459 36,000 23,700 12,300 104,000 56,900 47,100

Heart disease ...................... 391–392.0,393–398,402,404,410–416,420–429 25,800 *17,400 *8,400 63,300 *39,300 24,000

Diseases of the respiratory system ................................... 460–519 7,200 *4,400 * 35,600 25,500 10,100

Chronic obstructive pulmonary disease and allied conditions ................. 490–496 *6,000 *3,700 * 19,300 13,000 *6,300

Percent distribution

All diagnoses ...................................................... 100.0 100.0 100.0 100.0 100.0 100.0

Infectious and parasitic diseases .................................... 001–139 3.0 4.9 * 2.1 3.4 *

Acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) . 042–044 2.5 4.4 * 1.5 2.7 *

Neoplasms.................................................. 140–239 70.8 69.5 72.2 50.7 51.0 50.5

Malignant neoplasms .................................... 140–208,230–234 69.0 67.8 70.3 49.6 49.6 49.6

Endocrine, nutritional, and metabolic diseases and immunity disorders ............ 240–279 * * * 5.5 3.6 *7.4

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 * * * 2.4 *2.0 *2.9

Diseases of the circulatory system ................................... 390–459 11.0 13.8 7.8 14.7 15.8 13.6

Heart disease ...................... 391–392.0,393–398,402,404,410–416,420–429 7.9 *10.1 *5.4 8.9 *10.9 6.9

Diseases of the respiratory system ................................... 460–519 2.2 *2.6 * 5.0 7.1 2.9

Chronic obstructive pulmonary disease and allied conditions ................. 490–496 *1.8 *2.1 * 2.7 3.6 *1.8

* Figure does not meet standard of reliability or precision.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (12).

NOTES: Figures will not add to totals because not all diagnoses are shown. Percents are based on unrounded numbers.

Table 10. Number and percent distribution of men with malignant neoplasms discharged from hospice care by diagnostic category of

primary and all-listed diagnoses at admission: United States, 1993–94

Diagnostic category and ICD–9–CM code1

Primary

diagnosis

All-listed

diagnoses

Primary

diagnosis

All-listed

diagnoses

Number Percent distribution

Malignant neoplasms ....................... 140–208,230–234 116,200 179,100 100.0 100.0

Malignant neoplasm of trachea, bronchus, and lung .... 162,197.0,197.3 25,900 32,800 22.3 18.3

Malignant neoplasm of prostate . . . . . . . . . . . . . . . . . . . . . . . . 185 17,100 18,300 14.7 10.2

Malignant neoplasm of large intestine and rectum ...... 153–154,197.5 16,600 18,400 14.3 10.3

Malignant neoplasm of pancreas. . . . . . . . . . . . . . . . . . . . . . . . 157 * *9,500 * *5.3

Malignant neoplasm of lymphatic and hematopoietic tissue ....200–208 *7,700 *10,300 *6.6 *5.7

Malignant neoplasm of brain and spinal cord ........ 191,192.2,198.3 * 13,600 * 7.6

Malignant neoplasm of liver and intrahepatic bile ducts ...... 155,197.7 * 15,100 * 8.4

Malignant neoplasm of bone ...................... 170,198.5 * 12,600 * 7.0

* Figure does not meet standard of reliability or precision.

1Based on the International Classification of Diseases, 9th Revision, Clinical Modification (12).

NOTES: Figures will not add to totals because not all diagnoses are shown. Percents are based on unrounded numbers.

Advance Data No. 287 + April 25, 1997 11
Table 11. Number and percent distribution of women with malignant neoplasms discharged from hospice care by diagnostic category of

primary and all-listed diagnoses at admission: United States, 1993-94

Diagnostic category and ICD–9–CM code1 Primary

diagnosis

All-listed

diagnoses

Primary

diagnosis

All-listed

diagnoses

Number Percent distribution

Malignant neoplasms ......................... 140–208,230–234 110,100 172,100 100.0 100.0

Malignant neoplasm of large intestine and rectum ........ 153–154,197.5 *20,700 *22,300 *18.8 *13.0

Malignant neoplasm of trachea, bronchus, and lung ...... 162,197.0,197.3 19,500 26,700 17.7 15.5

Malignant neoplasm of breast.................... 174–175,198.81 16,800 17,700 15.3 10.3

Malignant neoplasm of female genital organs ........... 179–184,198.6 *7,700 8,200 *7.0 4.8

Malignant neoplasm of lymphatic and hematopoietic tissue ...... 200–208 *6,900 *9,400 *6.3 *5.5

Malignant neoplasm of pancreas. . . . . . . . . . . . . . . . . . . . . . . . . . 157 *5,300 *5,700 *4.8 *3.3

Malignant neoplasm of liver and intrahepatic bile ducts ........ 155,197.7 * 16,600 * 9.6

Malignant neoplasm of brain and spinal cord .......... 191,192.2,198.3 * 8,300 * 4.8

Malignant neoplasm of bone ........................ 170,198.5 * *11,200 * *6.5

* Figure does not meet standard of reliability or precision.

1

Based on the International Classification of Diseases, 9th Revision, Clinical Modification (12).

NOTES: Figures will not add to totals because not all diagnoses are shown. Percents are based on unrounded numbers.

12 Advance Data No. 287 + April 25, 1997
Technical notes

Following is a brief overview of the

data collection methods and estimation

procedures for the 1994 NHHCS. More

detailed information has been published

(7,8).

Sampling design

The sampling frame for the 1994

NHHCS consisted of all hospices and

home health care agencies that were

identified through the 1991 National

Health Provider Inventory (NHPI) (10)

or that had opened for business after the

1991 NHPI and before December 1994,

as identified through the Agency

Reporting System (ARS) (11). The

NHPI is a comprehensive census of

nursing and related care homes,

residential care homes, home health care

agencies, and hospices. It is conducted

periodically by NCHS.

The sample design for the 1994

NHHCS was a stratified three-stage

probability design. The first stage

consisted of the selection of geographic

areas called primary sampling units

(PSU’s)—counties, groups of counties,

county equivalents, or towns and

townships—throughout the United

States. At the second stage, a stratified

sample of hospices and home health

agencies was selected within the PSU’s.

Each agency was placed into one of six

strata based on type of agency (hospice

versus home health and mixed

agencies), type of PSU (self-representing

versus all others), and metropolitan

statistical area (MSA) status (MSA

versus non-MSA). Self-representing

PSU’s are the largest PSU’s in the

United States and were selected with

certainty (probability of 1). The other

PSU’s were not selected with certainty

(probability less than 1). MSA is defined

by the U.S. Office of Management and

Budget on the basis of the 1980 Census.

Within these sampling strata, agencies

were arrayed by four regions (Northeast,

Midwest, South, and West), five types of

ownership (for profit, nonprofit, State or

local government, Federal government,

and other), two types of certification

status (Medicare and Medicaid), and

size (number of current patients). These

categories were based on information

from the NHPI and the ARS.

The sample for the 1994 NHHCS

consisted of 1,510 agencies. Of these,

1,450 were found to be in scope for the

survey. Out-of-scope agencies were

those that were closed, were not

providing hospice or home health care

services to patients at the time of the

survey, or were duplicates of or had

merged with other sampled agencies. Of

the 1,450 in-scope agencies, 53 refused

to participate and 4 could not be

located. Ninety-six percent, or 1,393

agencies, agreed to participate.

The third stage of sample selection,

sampling of six current patients and six

discharges within each agency, was done

using a sample selection table to obtain

systematic probability samples of

current patients and of discharges. The

patients and discharges were selected

from lists constructed for each agency at

the time of the interview. Current

patients were defined as those patients

who were on the rolls of the agency as

of midnight on the day immediately

before the date of the survey. Discharges

referred to those patients who were

discharged from care by the hospice or

home health agency during a designated

month between October 1993 and

September 1994.

Data collection and processing

Data collection for the 1994

NHHCS began with a letter sent to all

sampled agencies informing the

administrator of the authorizing

legislation, purpose, and content of the

survey. Each agency was then contacted

by an interviewer to discuss the survey

and to arrange an appointment with the

administrator. During the appointment,

some information about the agency was

collected, as well as detailed information

about the current patients and discharges

for patients who received hospice and

home health care services from the

agency. All information was obtained by

personal interview with the

administrator or person designated by

the administrator; the respondent

referred to patient medical and other

records as necessary. No patient was

interviewed directly.

After the data had been collected

and converted into machine-readable

form, extensive editing was conducted

by computer to ensure that all responses

were accurate, consistent, logical, and

complete. The medical information

recorded on the patient questionnaires

was coded by NCHS staff according to

the International Classification of

Diseases, 9th Revision, Clinical

Modification (12). Up to 12 diagnostic

codes were assigned for each sample

patient (a maximum of 6 at admission,

and a maximum of 6 at time of survey

or discharge).

Estimation procedures

Statistics presented in this report

were derived by a multistage estimation

procedure (13) that produces essentially

unbiased national estimates and has

three principal components. The first

component, inflation by the reciprocals

of the probabilities of sample selection,

is the basic inflation weight. This

component consists of the inverse of the

probability of selecting (a) the PSU, (b)

the agency, and (c) the patient or

discharge within each agency. The

second component, which consists of an

adjustment for nonresponse, brings

estimates based only on the responding

cases up to the level that would have

been achieved if all eligible cases had

responded. The third component, ratio

adjustment to fixed totals, adjusts for

over- or undersampling of agencies

reported in the sampling frame.

Reliability of estimates and

tests of significance

Because the statistics presented in

this report are based on a sample, they

will differ somewhat from figures that

would have been obtained if a complete

census had been taken using the same

schedules, instructions, and procedures.

The standard error (SE) is primarily a

measure of the variability that occurs by

chance because a sample, rather than the

entire universe, is surveyed. The SE also

reflects part of the measurement error,

but it does not measure any systematic

biases in the data. The chances are

about 95 in 100 that an estimate from

the sample differs from the value that

would be obtained from a complete

Advance Data No. 287 + April 25, 1997 13
census by less than twice the SE.

However, SE’s typically underestimate

the true errors of the statistics because

they reflect only errors due to sampling.

The SE’s used in this report were

approximated using SUDAAN software.

SUDAAN computes SE’s by using a

first-order Taylor approximation of the

deviation of estimates from their

expected values. A description of the

software and the approach it uses has

been published (14). Exact SE estimates

were used in tests of significance in this

report.

The relative standard error (RSE) of

an estimate is obtained by dividing the

SE by the estimate itself. The result is

expressed as a percent of the estimate.

SE’s and RSE’s for aggregate estimates

of discharges presented in this report

may be estimated using the following

general formula, where X is the estimate

in thousands:

RSE(X) = Œ0.007581 +

208.593103

X

Because of the relationship between

the RSE and the estimate, the SE of an

estimate can be obtained by multiplying

the estimate by its RSE.

Publication of estimates for the

NHHCS is based on the RSE of the

estimate and the number of sample

records on which the estimate is based

(referred to as the sample size). If the

sample size is less than 30, the value of

the estimate is not reported. If the

sample size is 30–59, or the RSE is

30 percent or more, the estimate is

reported, but should not be assumed

reliable. This is indicated by an asterisk

(*) in the tables. If the sample size is 60

or more and the RSE is less than

30 percent, the estimate is reported and

is considered reliable.

14 Advance Data No. 287 + April 25, 1997
Suggested citation

Haupt BJ. Characteristics of hospice care

discharges: United States, 1993–94. Advance

data from vital and health statistics; no. 287.

Hyattsville, Maryland: National Center for

Health Statistics. 1997.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Director

Edward J. Sondik, Ph.D.

Deputy Director

Jack R. Anderson

DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

6525 Belcrest Road

Hyattsville, Maryland 20782

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DHHS Publication No. (PHS) 97-1250

7-0361 (4/97)

16 Advance Data No. 287 + April 25, 1997

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