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TRUE Hospice Utilization Project

Stratis Health, as a Medicare Quality Improvement Organization (QIO), led a one-year, community-based special innovation project funded by the Centers for Medicare & Medicaid Services to help eligible patients receive hospice care sooner, and to increase appropriate referrals to and utilization of hospice care.

While coverage for hospice services is available through Medicare, it is significantly underused by Medicare consumers across the country, including in Minnesota. Because many Medicare consumers enter hospice care late in the course of their life-limiting illness, they receive fewer days of care than afforded by the benefit. In 2011, the national average was 70 days per patient. Minnesota was significantly lower than the national average—the state’s Medicare hospice patients received only 56 days of hospice care on average. The 2012, national median length of stay was only 18.7 days, and 30 percent of all Medicare consumers who died were in hospice for three days or less.

Stratis Health’s Targeting Resource Use Effectively (TRUE) hospice utilization project worked with community partners to help health care providers identify patients who could most benefit from a hospice referral, and to recognize opportunities to encourage patient/provider conversations about hospice or other end of life care earlier in a patient’s course of treatment.

Project Brief > (2-page PDF)

Increasing Hospice Use: A TRUE Conversation This video explores the value that hospice care can bring to families facing a serious illness, and the challenges and opportunities that providers and patients have in addressing the “elephant in the examining room” – the difficulty of starting a conversation about hospice care. (8-minute video)

TRUE Hospice Project Resources

Hospice brochureEmpowering Community Partners Toolkit
This toolkit is aimed at supporting communities in helping eligible patients receive hospice care sooner.

TRUE Conversations. A discussion guide for community members to facilitate small-group discussions around health issues with the goal of empowering the group members to take charge of their health.



Patient/Family Brochures. A tri-fold brochure and a wallet card—for use by providers and lay community
members—which provide a short list of questions for patients and their families, so they can initiate a conversation with their doctor about their serious illness.

Ask Your Doctor: Elephant in the Exam Room brochure. (2-page PDF)

Ask Your Doctor: Elephant in the Exam Room brochure - customizable. (2-page Word doc)

Ask Your Doctor: Elephant in the Exam Room wallet card. (2-page PDF)

Resources to Communicate with Providers

Cover letter to providers. Customizable template that introduces providers to the patient “Ask your doctor” resources, the provider brochure, and the provider resource sheet. (1-page Word doc)

Is Your Patient’s Serious Illness the Elephant in the Examining Room? Provider brochure summarizing both community and healthcare provider perspectives on the barriers to more appropriate and timely use of hospice. (1-page PDF)

Provider Resources for Moving the Elephant Out of the Examining Room. Gives providers a different approach for identifying which patients to focus on for having conversations about serious or life-limiting illness. (2-page PDF)

PowerPoint Templates. Customizable PowerPoint templates, with speaker’s notes so you can give a hospice presentation.

Community Survey Guides. These community survey guides are intended to help hospice programs or others seeking to implement TRUE tools learn more about the perspectives of different people in their communities. Each of the guides includes a brief script and instructions for completing the form. Ideally, surveys with hospice patients and/or their families should be performed by hospice providers; surveys with community members should be performed by other community members; and surveys with healthcare providers should be done by other healthcare providers.

Community Member Survey Guide - customizable. (2-page Word doc)

Health Care Provider Survey Guide - customizable. (2-page Word doc)

Patient/family Survey Guide - customizable. (2-page Word doc)

Annotated hospice research references. Supporting information for access to hospice. (5-page PDF)

Hospice Data Collection Tool. Excel-based tool for collecting and tracking hospice utilization data. (4-worksheet spreadsheet)

Frequently Asked Questions. For use by health care professionals and lay community members. (2-page PDF)

Additional Resource

Circle in the Field: Hospice. Stories of the lived experience of handling a terminal diagnosis, focusing on what hospice and/or palliative care can do to allow the final days of a life to be peaceful and comfortable for a dying person, and for family and friends. Supported by Building Healthier Communities. (18-minute video)