Abstract
Background and Aim: Referral contracts are an avenue for understanding the organizational structure of different hospice organizations. The aim of the study is to determine whether an organization’s type and ownership impact patient referral patterns.

Methods: A cross-sectional retrospective study was conducted among a nationally weighted representative sample of 620 hospice agencies in the United States. The survey responses were collected using a stratified, multi-stage probability design.

Results: The data supported that hospice referral sources are impacted by organizational variations in ownership status. The data showed that 101(23.5%) of for-profit hospitals reported a hospital as their main referral source. Approximately 167(68.5%) of respondents reported hospitals which were the main referral sources, were part of a chain. For-profit hospice agencies were 7.82 times and 4.21 times more likely to have nursing homes and physicians’ offices as the main patient referral source. Not-for-profit hospices were 42% (adjusted odds ratio = 0.58; 95% confidence interval = 0.36–0.9) less likely to have administrators with a master’s administrator than those with a bachelor’s degree. Not-for-profit hospices were 4.42 times and 1.72 more likely to be part of a change and have no formal contracts with outside sources.

Conclusions: Hospice care is a comprehensive interdisciplinary approach to end-of-life care for patients. The referral sources are impacted based on their ownership status- es. Proper knowledge of hospice and hospice services delivery is essential to provide effective referrals. The data presents that internal and external factors play critical roles in the overall referral sources of hospice organizations.

Key words: Hospice care, referral sources, organization ownership, affiliation status