Though it is the common metric, hospice use is not really an indicator of quality of end-of-life care.

Instead, when researchers in the U.S. studied variations in patterns of hospice use between states, they found troubling trends.  Shi-Yi Wang, MD, PhD, Yale University School of Public Health and coauthors discuss the variations in the timing and duration of hospice enrollment and their implications in an article published in Journal of Palliative Medicine (doi:full/10.1089/jpm.2014.0425). They performed a retrospective analysis of Medicare patients who used hospice services during the last 6 months of their lives.

The researchers compared hospice use data on a state-by-state basis and identified important differences between states in the percentages of very short or very long hospice stays (reflecting late or early enrollment) and of patients leaving hospice before their deaths. Looking at overall, nationwide, hospice use alone as an indicator of quality of end-of-life care could mask issues that require attention.

"Hospice care should be the completion of good care," says Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine and Clinical Professor of Medicine, Ohio University. "However, as illustrated in this important work, how you use the hospice, analogous to how you take a medicine, is also important. You wouldn't expect benefit from just getting the prescription but not using it appropriately--the same is true for hospice care."