What is meant by U-shaped hospice services?

From the Guidelines

U-shaped hospice services refer to the pattern of care intensity that typically occurs during a patient's hospice journey, with most intensive care at the beginning and end of the hospice stay, and a period of relative stability in between. This pattern is characterized by high-intensity care when a patient initially enters hospice care and requires stabilization, followed by a period of fewer services needed as the patient's condition stabilizes, and then an increase in care intensity again as the patient approaches the end of life and symptoms intensify 1. The U-shaped pattern reflects the natural progression of terminal illness, where patients often need significant support during the transition into hospice care as their care plan is established and symptoms are brought under control. Some key points to consider in U-shaped hospice services include:

• The importance of timely referral to hospice care, as delayed referral can reduce the potential value of hospice services in consolidating grief preparation and acceptance 1
• The need for open and honest communication about death and dying, as well as the benefits of hospice care, to dispel misconceptions and promote a better understanding of the care options available 1
• The role of palliative care in improving the quality of life for patients with terminal illnesses, and the importance of introducing palliative care early in the disease trajectory 1. Understanding the U-shaped pattern of hospice services can help providers allocate resources effectively and prepare families for the changing intensity of services throughout the hospice experience. It is also important to note that the U-shaped pattern of care intensity is not unique to hospice care, but can also be observed in other forms of palliative care, such as comprehensive heart failure care, which integrates palliative care with guideline-directed management 1. Overall, the U-shaped pattern of hospice services highlights the importance of providing patient-centered care that addresses the unique needs and preferences of each individual, and promotes a better quality of life throughout the illness trajectory.

From the Research

Definition of U-Shaped Hospice Services

U-shaped hospice services refer to the pattern of service utilization in hospice care, where the intensity of services is higher at the beginning and end of the hospice episode, and lower in the middle portion.

Characteristics of U-Shaped Hospice Services

• The pattern of service utilization is characterized by a higher intensity of services at the beginning of the hospice episode, when patients require more intensive care and support 2, 3.
• The intensity of services decreases in the middle portion of the hospice episode, as patients' needs become more stable 2, 3.
• The intensity of services increases again at the end of the hospice episode, as patients' needs become more complex and require more intensive care and support 2, 3.

Implications of U-Shaped Hospice Services

• The U-shaped pattern of service utilization has implications for hospice payment methodologies, which should be designed to accommodate the varying intensity of services throughout the hospice episode 2.
• The pattern of service utilization also has implications for the management of hospice care, including the allocation of resources and the provision of support to patients and their families 3.

Research on U-Shaped Hospice Services

• Studies have confirmed the existence of the U-shaped pattern of service utilization in hospice care, using data from hospice patient electronic medical records and Medicare claims 2, 3.
• Research has also explored the factors that influence the pattern of service utilization, including patient characteristics, diagnosis, and length of stay 3.