DNP Final Report: Improving Rehospitalization Rates and Caregiver Quality of Life in Outpatient Hospice

Background: Hospital readmissions among home hospice patients disrupt continuity of care, increase healthcare costs, and may compromise end-of-life preferences. Purpose: This quality improvement project evaluated the feasibility of implementing a telehealth communication intervention in an outpatient hospice organization. Project aims were to reduce Type I live hospice discharges by at least 2.5% and improve caregiver quality of life (QOL). Methods: Zoom for Healthcare® video visits and three-way telephone communication supplemented standard nurse practitioner hospice visits during a three-month implementation period. Type I live discharge rates were compared with the organization's baseline quality metrics. Caregiver QOL was measured pre- and post-intervention using the Quality of Life in Life-Threatening Illness–Family Caregiver Version 3© (QOLLTI-F v3). Paired-samples t tests evaluated changes. Results: Among 67 hospice patients, no Type I live discharges occurred, exceeding the project goal. Caregiver overall QOL improved by a mean of 0.81 among participants completing both surveys (pre n=19; post n=9). Although statistical significance was not achieved (p=.08), the effect size was moderate (Cohen's d=0.67). Three domain-level QOL categories approached significance with p values ranging from (p ≈ .075–.11) including caregiver condition, outlook, and perceptions of patient condition. Conclusions: Telehealth was a feasible complement to standard hospice care and may reduce avoidable rehospitalizations while improving caregiver QOL. These findings support further evaluation in larger, more diverse populations and suggest telehealth is a scalable, sustainable model capable of improving hospice quality metrics, reducing healthcare expenditures, enhancing end-of-life experiences, and supporting caregiver well-being.