Abstract 20782: Discharge Hospice Referral is Associated With Lower 30-Day All-Cause Readmission in Hospitalized Patients With Heart Failure: A Propensity-Matched Study of the Medicare-Linked OPTIMIZE-HF
Bibliographic record
Abstract
Background: Heart failure (HF) is the leading cause for 30-day all-cause readmission - a target for Medicare cost reduction in the Affordable Care Act. Findings from a single state suggest that a discharge hospice referral was associated with lower 30-day all-cause readmission among Medicare beneficiaries hospitalized for HF during 1998-2001 (PMID: 26019151). We examined this association in a more contemporary national cohort of hospitalized patients with HF. Methods: In the Medicare-linked OPTIMIZE-HF registry, of the 25345 hospitalized patients with HF 479 (2%) received a discharge hospice referral. Of the 24866 patients who did not receive a hospice referral, 5053 (20%) died and were considered hospice eligible (6-month life expectancy is a Medicare hospice eligibility criterion). Propensity scores for hospice referral were estimated for each of the 5532 (479+5053) patients and were used to match 360 hospice-referral patients with 360 hospice-eligible patients who were balanced on 78 baseline characteristics. The 720 matched patients had a mean (±SD) age of 80 (±10) years, a mean (±SD) EF of 40% (±18%), 52% were women, and 09% African American. Results: 30-day all-cause readmission occurred in 42% and 6% of matched hospice-referral and hospice-eligible patients, resp. (HR, 0.17; 95% CI, 0.12-0.25; Figure ). While 30-day mortality was higher in the hospice referral group (61% vs 27%), the higher mortality was unlikely to have explained this lower readmission rate. At 6 month, mortality was lower in the hospice referral group (81% vs 100% in the hospice-eligible group, by definition) and yet hospice referral was associated with lower 6-month all-cause readmission (HR, 0.16; 95% CI, 0.11-0.22). Patients in the hospice referral group had lower 30-day and 6-month HF readmissions. Conclusion: Among hospitalized patients with HF, a discharge hospice referral was associated with lower 30-day all-cause readmission, which persisted during longer term follow-up.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".