ICU to Hospice Transitions Are Increasing. What Should We Measure Now?

What the study examined

A new national study examined US Medicare fee-for-service beneficiaries over age 65 who were admitted to an ICU between 2011 and 2023. The authors found that discharges to hospice after ICU admission increased substantially over time, including an increase in hospice discharges per 100,000 beneficiaries and a rise in the proportion of ICU patients discharged to hospice. Notably, these changes occurred while in-hospital mortality and 30-day mortality remained stable, suggesting the trend is not simply explained by sicker hospitalized patients.

What else changed over time

The study also adds important context for hospice and palliative care teams working with hospitals. Over the same period, documented DNR orders and claims for palliative care delivery increased, while median hospital length of stay remained relatively stable. The authors note that the COVID-19 years were associated with temporary increases in mortality and other measures, but without a parallel rise in discharge to hospice, followed by a return toward pre-COVID trend trajectories. At the hospital level, the analysis suggests a growing share of short-term decedents were transitioned to hospice prior to death but variation across hospitals persists.

Questions hospice clinicians and leaders can ask next

For hospice professionals, the most useful question may be what we should measure next. If hospice discharge is increasing, how do we evaluate whether the transition was timely, informed, and truly goal-concordant? What does a high-quality ICU-to-hospice transition look like in your community? How should we track outcomes after enrollment such as symptom burden, caregiver experience, and avoided unwanted interventions? Where might variation reflect thoughtful local practice, and where might it reflect inequities in access, communication, or referral pathways that we can actively improve?

References and further reading

• 2011 to 2023 Saw Rise in Discharges to Hospice after ICU Admission
• Teno JM, et al. Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000-2015 (JAMA, 2018)
• Davidson JE, et al. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU (Crit Care Med, 2017)
• Hua M, et al. Association between the availability of hospital-based palliative care and treatment intensity for critically ill patients (Ann Am Thorac Soc, 2018)