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Research

Hospice Use after ICU Admission Increased Across the US from 2011-2023

Trend has major implications for understanding end-of-life planning and health system resource needs.

In recent years, medical guidelines and national policies have pushed hospitals to offer more palliative care to patients who are seriously ill. This has led to a major rise in palliative care use, especially among people treated in ICUs. Although past research suggested that palliative care can help patients transition to hospice, the actual trends in hospice use after critical illness have not been described.

This finding matters because millions of families face decisions about end-of-life care every year.

Anica Law, MD, MS, assistant professor of medicine

In a new study from Boston University Chobanian & Avedisian School of Medicine, researchers have found that more older adults in the U.S. are being discharged to hospice after an ICU stay than in the past, and this increase happened even as overall short-term death rates stayed stable. This research is the first to quantify hospice use after ICU stays on a national scale, and suggests a real shift in how end-of-life care is delivered to the seriously ill.

“This finding matters because millions of families face decisions about end-of-life care every year. ICU care is intense and invasive, and many of the life-sustaining treatments offered long-term may not be what patients want near the end of life. Seeing more people move to hospice suggests that hospitals may be focusing more on helping patients at high risk of death choose comfort-focused care,” explains corresponding author Anica Law, MD, MS, assistant professor of medicine at the school, and pulmonologist and critical care physician at Boston Medical Center.

The researchers analyzed Medicare data from all fee-for-service Medicare patients (more than 10 million people) over the age of 65 who were admitted to an ICU between 2011 and 2023 and measured rates of discharge to hospice, short-term death, as well as do-not-resuscitate (DNR) orders and palliative care use in the hospital. They then assessed how these changed from year to year to understand whether hospice use was increasing and if hospitals were handling end-of-life transitions differently over time. They found discharges to hospice after ICU admission increased from 5.6% to 6.8% (or 388 to 572 per 100,000 Medicare beneficiaries), while in-hospital mortality and 30-day mortality trends remained stable. DNR orders and palliative care delivery also increased over the same timeframe.

According to the researchers, the study shows that the way people are cared for near the end of life is changing across the entire country. “Because the alternatives to comfort-focused care often involve invasive and prolonged life support that can be hard on patients, families, and the healthcare system, understanding these trends is crucial. Understanding the trends is the first step to planning further efforts to help ensure that people nearing the end of life receive care that truly reflects their needs and values,” said Law.

These findings appear online in the Annals of the American Thoracic Society.