Health Care Worker Perceptions of Gaps and Opportunities to Improve Hospital-to-Hospice Transitions

UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Health Services Administration | Health Services Research | Palliative Care


Background: Care transitions from the hospital to hospice are a difficult time, and gaps during this transitions could cause poor care experiences and outcomes. However, little is known about what gaps exist in the hospital-to-hospice transition.

Objectives: To understand the process of hospital-to-hospice transition and identify common gaps in the transition that result in unsafe or poor patient and family caregiver experiences.

Design: We conducted a qualitative descriptive study using semistructured interviews with health care workers who are directly involved in hospital-to-hospice transitions. Participants were asked to describe the common practice of discharging patients to hospice or admitting patients from a hospital, and share their observations about hospital-to-hospice transition gaps.

Setting/Subjects: Fifteen health care workers from three hospitals and three hospice programs in Portland, Oregon.

Measurements: All interviews were audio recorded and analyzed using qualitative descriptive methods to describe current practices and identify gaps in hospital-to-hospice transitions.

Results: Three areas of gaps in hospital-to-hospice transitions were identified: (1) low literacy about hospice care; (2) changes in medications; and (3) hand-off information related to daily care. Specific concerns included hospital providers giving inaccurate descriptions of hospice; discharge orders not including comfort medications for the transition and inadequate prescriptions to manage medications at home; and lack of information about daily care hindering smooth transition and continuity of care.

Conclusion: Our findings identify gaps and suggest opportunities to improve hospital-to-hospice transitions that will serve as the basis for future interventions to design safe and high-quality hospital-to-hospice care transitions.


care transitions, discharge planning, hospice

DOI of Published Version



J Palliat Med. 2019 Dec 31. doi: 10.1089/jpm.2019.0513. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title

Journal of palliative medicine

PubMed ID


Related Resources

Link to Article in PubMed