reporting dementia on hospice claims of nursing home residents dying with advanced dementia (312-c)

340 Vol. 43 No. 2 February 2012Schedule With Abstracts

Reporting Dementia on Hospice Claims ofNursing Home Residents Dying WithAdvanced Dementia (312-C)Susan Miller, PhD, Brown University, Provi-dence, RI. Julie Lima, PhD MPH, Brown Uni-versity, Providence, RI. Susan Mitchell, MDMPH, Harvard University Hebrew Senior Life,Boston, MA.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Describe what diagnoses are documented on

hospice claims for nursing home residentsdying with advanced dementia and onhospice.

2. Discuss the factors associated with the ab-sence of dementia diagnoses on hospiceclaims for nursing home residents dyingwith advanced dementia and on hospice.

Background. Nearly 40% of nursing home (NH)residents with advanced dementia receive NHhospice care prior to death.

Research objectives. To describe diagnoses onhospice claims for NH residents with advanceddementia and examine factors associated withthe absence of dementia diagnoses.

Method. This cross-sectional study included USNH residents dying with Medicare hospicecare in 2006 and identified as having advanceddementia (36,865). Resident assessment(MDS) data linked to Medicare claims and de-nominator data was used to identify residentcharacteristics, NH death, and the presence ofadvanced dementia. Advanced dementia wasidentified by a diagnosis of Alzheimer’s diseaseor dementia on the MDS or a Medicare Part-Aclaim in the last year of life and documentationon the MDS of severe to very severe cognitiveimpairment (a score of 5 or 6 on the MDS cog-nitive performance scale). Hospice providerswere characterized by their 2006 fiscalintermediaries and by data in the hospice pro-vider of service file. Multi-level logit regressionanalysis was used to examine the factors associ-ated with the absence of a coded dementia diag-nosis on the last hospice claim and with thepresence of a debility or failure to thrive diagno-sis (and no dementia diagnosis).

Result. 44% (16,293) of US NH hospice dece-dents identified as having advanced dementiadid not have dementia diagnoses documented.Of these, debility (3,122; 19.2%) and failure to

thrive (2,520; 15.5%) were most frequently re-ported. Controlling for resident characteristicsand regional variation, a hospice’s fiscal interme-diary was significantly associated with the likeli-hood of a claim having a debility or failure tothrive diagnosis (p < .001).

Conclusion. Dementia is underreported on hos-pice claims and the documentation of debility orfailure to thrive (without dementia) may be overreported.

Implications for research, policy, or practice.The underreporting of dementia on hospiceclaims results in inaccurate portrayals of the re-ceipt of hospice care received by persons withdementia.

‘‘My Baby Is A Person’’: Parents’Experiences With Life-Threatening FetalDiagnosis (313-A)Erin Denney-Koelsch, MD, University of Roches-ter, Rochester, NY. Denise Cote-Arsenault, PhDRNC FNAP, University of Rochester, Manlius,NY.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. List three concerns raised by parents in their

interactions with medical providers.2. Describe the disconnect between parental ex-

periences of pregnancy with a LFD and theresponse of others to the situation.

3. State one approach that could be used to le-gitimize the personhood of these families’unborn baby.

Background. Diagnosis of a lethal fetal diagnosis(LFD) early in pregnancy is devastating for par-ents. Those who choose to continue with thepregnancy report intense emotional reactionsand inconsistent, often insensitive treatment byhealthcare providers.

Research objectives. We sought to clarify the ex-periences and needs of families in order to de-sign responsive perinatal palliative care servicesand to establish the feasibility and acceptabilityof conducting intensive interviews of pregnantwomen and their partners during their preg-nancy with a LFD.

Method. In this qualitative descriptive study, weinterviewed two women and three couples dur-ing pregnancy or just after birth, using open-