Are Hospice Admission Practices Associated With Hospice Enrollment for Older African Americans and Whites?

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• 作者：Kimberly S. Johnson ; MD ; MHS^a ; ^b ; ^c ; ^d ; ^h ; ^{kimberly.s.johnson@dm.duke.edu" class="auth_mail" title="E-mail the corresponding author} ; Richard Payne ; MD^a ; ^b ; ^c ; ^e ; Maragatha N. Kuchibhatla ; PhD^c ; ^f ; James A. Tulsky ; MD^a ; ^c ; ^d ; ^g ; ⁱ
• 关键词：Hospice ; African Americans ; racial disparities ; end-of-life care
• 刊名：Journal of Pain and Symptom Management
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：51
• 期：4
• 页码：697-705
• 全文大小：147 K

文摘

Hospices that enroll patients receiving expensive palliative therapies may serve more African Americans because of their greater preferences for aggressive end-of-life care.

Objectives

Examine the association between hospices' admission practices and enrollment of African Americans and whites.

Methods

This was a cross-sectional study of 61 North and South Carolina hospices. We developed a hospice admission practices scale; higher scores indicate less restrictive practices, that is, greater frequency with which hospices admitted those receiving chemotherapy, inotropes, and so forth. In separate multivariate analyses for each racial group, we examined the relationship between the proportion of decedents (age ≥ 65) served by a hospice in their service area (2008 Medicare Data) and admission practices while controlling for health care resources (e.g., hospital beds) and market concentration in the area, ownership, and budget.

Results

Nonprofit hospices and those with larger budgets reported less restrictive admission practices. In bivariate analyses, hospices with less restrictive admission practices served a larger proportion of patients in both racial groups (P < 0.001). However, in the multivariate models, nonprofit ownership and larger budgets but not admission practices predicted the outcome.

Conclusion

Hospices with larger budgets served a greater proportion of African Americans and whites in their service area. Although larger hospices reported less restrictive admission practices, they also may have provided other services that may be important to patients regardless of race, such as more in-home support or assistance with nonmedical expenses, and participated in more outreach activities increasing their visibility and referral base. Future research should explore factors that influence decisions about hospice enrollment among racially diverse older adults.