{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:01:48Z","timestamp":1777384908205,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,11,16]],"date-time":"2025-11-16T00:00:00Z","timestamp":1763251200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Appropriately using resources is challenging for emergency providers managing hospice patients who desire palliative, rather than curative, care. In the Emergency Department (ED), the goals of such visits may be unclear. Our study examined the chief complaints of hospice patients presenting to the ED and associations with ambulance use, advanced imaging, and hospital admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review was conducted of 2678 visits by 1281 hospice patients from 2017-2022 in a rural health system in Appalachia. Data collection included demographics, chief complaint, mode of arrival, disposition, and use of advanced imaging. Statistical analyses for associations were conducted using the Chi-Square test and post-hoc analysis with Bonferroni correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Respiratory, abdominal, neurologic, and trauma complaints were most common. Ambulance was the mode of arrival for 65.8% and was associated with neurologic concerns and trauma (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Advanced imaging was used in 55.0% of visits and was associated with abdominal concerns, neurologic issues, and trauma (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Admission occurred in 64.4% and was significantly associated (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) with neurologic, respiratory, and weakness complaints.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The most frequent reasons for ED visits by hospice patients in this study included respiratory, abdominal, neurologic, and trauma complaints. Most ED hospice patients used ambulance services and advanced imaging resources and were admitted. When the goals of the visit are unclear, the ED provider may default to ordering evaluations. Further studies are needed to determine how to best provide goal-concordant support for hospice patients with emergent medical needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091251399808","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T05:09:33Z","timestamp":1763356173000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Characterizing the Use of Emergency Department Resources and Dispositions of Hospice Patients in an Appalachian Region of the United States"],"prefix":"10.1177","author":[{"given":"Alexis Hernandez","family":"Abrego","sequence":"first","affiliation":[{"name":"West Virginia University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison","family":"Tadros","sequence":"additional","affiliation":[{"name":"West Virginia University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3969-6186","authenticated-orcid":false,"given":"Janna","family":"Baker Rogers","sequence":"additional","affiliation":[{"name":"West Virginia University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0392-3364","authenticated-orcid":false,"given":"Stephen M.","family":"Davis","sequence":"additional","affiliation":[{"name":"West Virginia University"},{"name":"West Virginia University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Dilcher","sequence":"additional","affiliation":[{"name":"West Virginia University"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,11,16]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2020.08.009"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-684x-13-35"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13948"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2024.12.016"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17144955"},{"key":"e_1_3_6_7_2","volume-title":"Hospice Chartbook","author":"Research Institute for Home Care","year":"2024","unstructured":"Research Institute for Home Care. Hospice Chartbook. NHPCO, 2024. https:\/\/researchinstituteforhomecare.org\/hospice-chartbook\/. Accessed November 4, 2025."},{"key":"e_1_3_6_8_2","volume-title":"Hospice: Philosophy of Care and Appropriate Utilization in the United States","author":"Meier DE","year":"2025","unstructured":"Meier DE, McCormick E, Lagman RL, Arnold RM, eds. Hospice: Philosophy of Care and Appropriate Utilization in the United States. UpToDate, 2025. https:\/\/www.uptodate.com\/contents\/hospice-philosophy-of-care-and-appropriate-utilization-in-the-united-states#H4568091"},{"key":"e_1_3_6_9_2","unstructured":"American Cancer Society. What is hospice care? https:\/\/www.cancer.org\/cancer\/end-of-life-care\/hospice-care\/what-is-hospice-care.html. 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National hospital ambulatory medical care survey: 2021 emergency department summary tables. 2021. https:\/\/ftp.cdc.gov\/pub\/Health_Statistics\/NCHS\/Dataset_Documentation\/NHAMCS\/doc21-ed-508.pdf","DOI":"10.15620\/cdc:121911"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2015.0550"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2021.09.025"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2021.1900474"},{"key":"e_1_3_6_17_2","unstructured":"National Alliance for Care at Home. Rural American hospice insights: understanding the needs of the rural family caregiver. 2024. https:\/\/allianceforcareathome.org\/wp-content\/uploads\/Rural_American_Hospice-_Insights_Report.pdf. Accessed August 15 2025."},{"key":"e_1_3_6_18_2","unstructured":"Mercatus Center George Washington University. Certificate of need laws: west Virginia state profile. 2020. https:\/\/www.mercatus.org\/system\/files\/xxxx_constateprofile_2020.pdf. Accessed September 12 2025."},{"key":"e_1_3_6_19_2","volume-title":"The uncertain future of hospice certificates of need","author":"Vossel H","unstructured":"Vossel H. The uncertain future of hospice certificates of need. Hospice News. https:\/\/hospicenews.com\/2022\/06\/28\/the-uncertain-future-of-hospice-certificates-of-need\/"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/10499091231180613"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/10499091231194726"},{"key":"e_1_3_6_22_2","volume-title":"MPA. 2025. Report to Congress: Medicare Payment Policy","author":"Medicare Payment Advisory Commisson","unstructured":"Medicare Payment Advisory Commisson. MPA. 2025. Report to Congress: Medicare Payment Policy. 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