Characteristics of patients utilizing general inpatient (GIP) hospice.
Authors: Shalavadi Megha , Garrigues Sarah K. , Hansen Jennifer , Nawabi Tiffany , Gegg-Mitchell Jevon , Maeda Lauren Shizue , Brar Rondeep Singh , Srinivas Sandy , Khaki Ali Raza 
Published: October 2023

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Background: GIP hospice acute care is an inpatient designation for patients (pts) with terminal illness and clinical need to manage uncontrolled symptoms that cannot be managed in other settings. We recently revised hospital workflows to streamline GIP enrollment when appropriate. This study investigates the GIP utilization patterns and characteristics of pts with cancer on GIP. Methods: In December 2022, in collaboration with a consulting hospice program, we revised hospital workflows to improve access to and increase provider and pt awareness about GIP hospice for eligible pts at our academic cancer center. In this study, we review the use of GIP services in hospitalized pts with cancer since the revised workflow. We investigate pt demographics, care utilization (chemotherapy use, hospital readmission) and advanced care planning (ACP) documentation. All data presented are descriptive. Results: A total of 44 pts with cancer enrolled in GIP hospice between 12/2022 and 5/2023 after workflow optimization. This rose from 9 pts in the preceding 6 months prior to revised workflow. Median age was 67 years (range 29-90); 57% were male; 41% were White, 34% were Asian, 5% were Black, and 18% were Other Race; 18% had a hematologic malignancy, and all other pts (82%) had metastatic solid tumors (gastrointestinal, genitourinary, and thoracic diseases most prevalent). 82% listed English as the primary language, and 11% needed an interpreter. 48% had Medicare, 16% had Medicaid, and 36% had private insurance. 98% of the pts had uncontrolled pain as the predominant symptom necessitating inpatient hospice. Among enrolled pts, 98% died on GIP, with a median length of stay preceding GIP of 11.5 days and 2 days on GIP. 39% of pts transitioned to GIP during their first hospitalization within 90 days of death, while 52% had hospital readmissions with a median of 2 admissions in the 90 days prior to death. 18% (8/44) received chemotherapy within 30 days of death (38% [n=3] with curative intent). Notably, the median length of time pts had been followed by their outpatient oncologist was 22 months, and only 18% had fewer than 3 months history at our cancer center. 48% utilized outpatient palliative care prior to death. ACP documentation was completed for 61% of pts (45% with documented prognosis), though only 27% had any documentation by their primary oncologist. Conclusions: Our pilot to identify pts eligible for GIP who could benefit from this care at end of life was successful in increasing utilization of this service. Most pts dying in the hospital on GIP had metastatic solid tumors, with two hospitalizations in the months prior to death. Most pts also had a well-established relationship in the oncology clinic but still had no prior utilization of hospice and only benefitted from a median of 2 days on GIP hospice prior to death. Additional data is needed to understand perspectives and barriers to utilization of outpatient hospice and palliative care resources.