Diagnostic Criteria for Admitting COPD Patients to Hospice Care

Primary Criteria for Hospice Eligibility in COPD

• Patients with severe COPD qualify for hospice care when they have disabling dyspnea at rest, evidence of disease progression, and a prognosis of less than 6 months to live as determined by both the treating physician and hospice medical director, according to the American College of Physicians and supported by Praxis Medical Insights 1
• The American Thoracic Society recommends that patients must have severe COPD with disabling dyspnea at rest that significantly limits activity and is poorly responsive to bronchodilators 2, 1
• Evidence of disease progression must be present, including at least one of the following: frequent exacerbations (two or more per year) despite adequate treatment, as stated by the European Respiratory Society 3, 4
• Previous hospitalizations for COPD exacerbations, especially those requiring ICU admission, are a key factor in determining hospice eligibility, according to the European Respiratory Society 3, 5
• Severe airflow obstruction with significant lung function impairment despite optimal treatment is a primary criterion for hospice eligibility, as recommended by the European Respiratory Society 3, 6
• Hypoxemia at rest or hypercapnia on ambient air is a key indicator of disease progression, according to the American Journal of Respiratory and Critical Care Medicine 7, 1
• Requirement for long-term oxygen therapy (LTOT) is a supporting criterion for hospice eligibility, as stated by the European Respiratory Journal and the American Journal of Respiratory and Critical Care Medicine 8, 7

Supporting Criteria

• Right heart failure secondary to pulmonary disease (cor pulmonale) is a supporting criterion for hospice eligibility, according to Praxis Medical Insights 1
• Unintentional progressive weight loss (>10% over last 6 months) is a key indicator of disease progression, as stated by the European Respiratory Journal and Praxis Medical Insights 8, 1
• Resting tachycardia >100 beats/min is a supporting criterion for hospice eligibility, according to Praxis Medical Insights 1
• Rapidly progressive course of disease with decline in lung function, progressive dyspnea, and decreased exercise tolerance is a key factor in determining hospice eligibility, as recommended by the European Respiratory Journal 9, 8
• Need for increasing visits to the emergency department or hospitalizations for respiratory infections and/or respiratory failure is a supporting criterion for hospice eligibility, according to the European Respiratory Journal and the American Journal of Respiratory and Critical Care Medicine 5, 2

Process for Hospice Referral

• Certification that the patient's prognosis is terminal (less than 6 months) must be determined by both the treating physician and hospice medical director, as required by Praxis Medical Insights 1
• Patients must agree in writing that hospice care will be used to treat their terminal illness, according to Praxis Medical Insights 1
• A "do not attempt resuscitation" order is not required for enrollment in hospice programs, as stated by the American Journal of Respiratory and Critical Care Medicine and Praxis Medical Insights 2, 1
• Patients can be withdrawn from hospice if their condition unexpectedly improves, according to the American Journal of Respiratory and Critical Care Medicine 2, 11