Hospice care for patients with dementia: does volume make a difference?

Using the repository of 2005 Family Evaluation of Hospice Care data, this study examined whether bereaved family members report higher quality of care when hospices care for greater vs. lesser proportions of dementia patients. This organization-level analysis included 396 hospices meeting the study's eligibility criteria. Using hospice percentages of the "proportion of decedents with dementia," categories representing the lower three, the fourth and highest quintile values were created (i.e., <13%, > or =13%-19%, and > or =19%). Analyses were stratified by for-profit vs. not-for-profit because preliminary analyses showed differential associations by profit status. In for-profit hospices, hospices with the highest vs. lowest proportion of dementia patients (> or =19% vs. <13%) had significantly lower unmet pain needs (-1.7%, 95% confidence interval [CI] -3.1%, -0.2%). However, for both profit groups, caring for > or =19% dementia decedents (vs. <13%) was associated with a lower proportion of "excellent" care ratings (-2.3%, 95% CI -4.5%, -0.2%). Statistically significant associations between higher volume and better ratings were not observed for the remaining (six) outcomes, although this trend was found more among for-profit hospices. Thus, profit status appears to modify the association between volume of dementia care and care ratings. Further study is needed to understand the nonintuitive negative association between higher volume and lower satisfaction. This study emphasizes the need for examination of quality outcomes by profit status.