Predicting emergency room visits and hospitalizations among hospice patients with cardiac disease.

BACKGROUND: One goal of quality palliative care in hospice is to limit emergency room visits and/or hospitalizations (ERVH). PURPOSE: The purpose of this study was to determine predisposing factors that contribute to ERVH and devise a model to predict the probability of hospice cardiac disease patients having ERVH after hospice admission. METHODS: The study was a retrospective chart review of hospice cardiac patients comparing those with ERVH (n = 65) and those who died in their homes (n = 80). Data reduction strategy included bivariate tests and model-building analyses using logistic regression analysis. RESULTS: Some factors were associated with decreased odds of having ERVH: older patients (odds ratio [OR] = 0.94; p = 0.001), increased nursing visits (OR = 0.79; p = 0.001) and chaplain visits (OR = 0.48; p = 0.040), patients' medication compliance (OR = 0.27; p = 0.029), patients treated with morphine sulfate (OR = 0.15; p = 0.001), patients with caregiver(s) (OR = 0.09; p = 0.012), patients with hospice emergency kits (OR = 0.33; p = 0.004), interaction of the latter two variables (OR = 0.26; p = 0.001), patients with do-not-resuscitate orders (OR = 0.29; p = 0.001), Caucasian patients (OR = 0.22; p = 0.001), and the interaction of the latter two variables (OR = 0.22; p = 0.001). Other factors were associated with increased odds of having ERVH: patients with diabetes (OR = 2.64; p = 0.009), peripheral vascular disease (OR = 5.30; p = 0.003), hyperlipidemia (OR = 4.52; p = 0.013), chronic pulmonary disease/asthma (OR = 2.83; p = 0.003) as comorbidities; palpitations (OR = 6.61; p = 0.010), and chest pain (OR = 3.78; p = 0.006). The best fitting forecasting model had six independent variables decreasing and two increasing the odds of having ERVH. The final model chosen was: Z = 7.817 + 2.929 (peripheral vascular disease) + 1.513 (diabetes mellitus) - 3.306 (Caucasian) - 1.824 (caregiver presence x hospice emergency kit at home) - 0.212 (frequency of nursing visits) - 3.275 (on morphine) - 4.422 (medication compliance). CONCLUSION: The forecasting model predicted the probability of ERVH correctly in 87.7% of the patients. The model is simple to use to predict hospice cardiac patients having ERVH. Future studies should validate this model. Interventions should utilize these factors and be evaluated to determine their ability to decrease ERVH in hospice cardiac patients.

Spirituality and job satisfaction among hospice interdisciplinary team members.

As a continuing effort to enhance the quality of palliative care for the dying, this study examined (1) the prevalence of spirituality among hospice interdisciplinary team (IDT) members; (2) whether spirituality is related to job satisfaction; and (3) the structural path relationships among four variables: spiritual belief, integration of spirituality at work, self actualization and job satisfaction. The study surveyed 215 hospice IDT members who completed the Jarel Spiritual Well-Being Scale, the Chamiec-Case Spirituality Integration and Job Satisfaction Scales. Multiple regression and structural path modeling methods were applied to explain the path relationships involving all four variables. The IDT members surveyed were: nurses, 46.4%; home health aids, 24.9%; social workers, 17.4%; chaplains, 4.2%; physicians, 2.3%; and other, 4.8%. Ninety-eight percent of the respondents viewed themselves as having spiritual well-being. On a 0-100 scale, IDT staff reported high spiritual belief (mean = 89.4) and they were self-actualizing (mean = 82.6). Most reported high job satisfaction (mean = 79.3) and spiritual integration (mean = 67.9). In multiple regression, spirituality, integration and self-actualization explained 22% of the variation in job satisfaction (R = 0.48; adjusted R(2) = 0.218; df = 3,175; F = 17.2; p = 0.001). Structural path models revealed that job satisfaction is more likely to be realized by a model that transforms one's spirituality into processes of integrating spirituality at work and self actualization (chi(2) = 0.614; df = 1; p = 0.433) than a model that establishes a direct path from spirituality to job satisfaction (chi(2) = 1.65; df = 1; p = 0.199). Hospice IDT member's integration of their spirituality at work and greater self actualization significantly improve job satisfaction.