Hudson Student Research Highlights Geographic Differences in Hospice Care Quality Across the United States

At this year’s Innovations in Aging Day, Jude Abueisheh, a Master of Health Administration (MHA) candidate at the Hudson College of Public Health, presented research examining how the quality of hospice care varies over time and across the United States.

Her presentation, “Temporal and Geographic Variation in Hospice Quality of Care,” explores national trends in hospice services and provides insight into how patients and families experience end-of-life care. The research highlights the importance of understanding how health care systems, resources and local conditions influence the delivery of quality care.

Working alongside collaborators Dr. Ganisher (Gani) Davlyatov and Dr. Aizhan Karabukayeva, Jude analyzed national hospice data from the Centers for Medicare & Medicaid Services (CMS). The team examined key quality indicators connected to the Medicare Hospice Benefit, including measures from the Hospice Quality Reporting Program and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey.

The study evaluated changes in hospice quality over time, as well as differences between states in areas such as staffing, spending, service delivery and patient outcomes.

The findings showed that several clinical process measures improved over the study period. Measures such as Hospice Visits in the Last Days of Life and the Hospice and Palliative Care Composite Process Measure increased, and average CMS Star Ratings showed modest improvement.

However, patient and family experience measures told a different story. CAHPS hospice ratings showed limited improvement and, in some areas, slight declines — suggesting that improvements in clinical processes do not always translate into better experiences for patients and caregivers.

The team’s analysis of 2023 state-level data also revealed significant geographic variation in hospice care across the country. Factors such as spending per patient, staffing levels and hospice market availability varied widely between states. Quality measures, including the frequency of hospice visits during the final days of life, also differed substantially depending on location.

The findings suggest that hospice quality and resource use may be strongly influenced by regional health care environments and local market conditions, highlighting the need for continued research into how communities can support consistent, high-quality end-of-life care.

Jude’s work reflects the strong research engagement of HCOPH students and the College’s commitment to preparing future health leaders to address complex challenges in health care delivery. Through research like this, HCOPH students contribute to efforts to improve health outcomes and strengthen systems of care for communities across the nation.