Differences in Hospice Use Between Black and White Patients During the Period 1992 through 2000

Han, Beth; Remsburg, Robin E.; Iwashyna, Theodore J.

doi:10.1097/01.mlr.0000215858.37118.65

Cited by 34 publications

(36 citation statements)

References 21 publications

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“…We ran logistic regression models using indicator variables to examine the relationship between these groups and odds of readmission, first using only age for risk-adjustment (Model 1), and next using our formal risk-adjustment scheme 15, 16 (Model 2). We added discharge destination (home, nursing or rehabilitation facility, hospice, or other) to our model for each condition, as well as length of stay, to address possible confounding by these factors (Model 3), 24, 25 and then added hospital characteristics including size, system membership, teaching status, ownership, location, and region (Model 4). We then added the proportion of Medicaid patients and each hospital’s Disproportionate Share Index, 26, 27 as proxies for the proportion of poor patients a hospital serves (Model 5).…”

Section: Methodsmentioning

confidence: 99%

Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care

Joynt¹

2011

JAMA

646

455

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Context Understanding whether and why there are racial disparities in readmissions has implications for efforts to reduce readmissions. Objective To determine whether black patients have higher odds of readmission than white patients, and if these disparities are related to where black patients receive care. Design Using national Medicare data, we examined 30-day readmissions after hospitalization for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia. We categorized hospitals in the top decile of proportion of black patients as “minority-serving.” We determined the odds of readmission for black patients compared with white patients at minority-serving versus non-minority-serving hospitals. Setting U.S. hospitals. Participants 3.1 million Medicare fee-for-service recipients, discharged in 2006–2008. Intervention None. Main Outcome Measure Risk-adjusted odds of 30-day readmission. Results Overall, black patients had higher readmission rates than white patients (24.8% versus 22.6%, odds ratio [OR] 1.13, 95% confidence interval [CI] 1.11 to 1.14, p<0.001); patients from minority-serving hospitals had higher readmission rates than those from non-minority-serving hospitals (25.5% versus 22.0%, OR 1.23, 95% CI 1.20, 1.27, p<0.001). Among AMI patients, using white patients from non-minority-serving hospitals as our reference group (readmission rate 20.9%), we found that black patients from non-minority-serving hospitals had the highest readmission rate (26.4%, OR 1.20, 95% CI 1.16, 1.23), while white patients from minority-serving hospitals had a 24.6% readmission rate (OR 1.23, 95% CI 1.18, 1.29) and black patients from minority-serving hospitals had a 23.3% readmission rate (OR 1.35, 95% CI 1.28, 1.42, p<0.001 for each); patterns were similar for CHF and pneumonia. The results were unchanged after adjusting for hospital characteristics including markers of caring for poor patients. Conclusions Among elderly Americans, black patients were more likely to be readmitted after hospitalization for three common conditions, a gap that was related to both race and to the site where care was received.

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Section: Methodsmentioning

confidence: 99%

Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care

Joynt¹

2011

JAMA

646

455

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“…Understanding advance care planning as a process of health behavior is one aspect of end-of-life decision making (Fried, Bullock, Iannone, & O'Leary, 2009). More specifically, the constant racial disparities in the utilization of hospice care between Black and White patients are of concern (Han, Remsburg, & Iwashyna, 2006). For the past 5 years, there has been little to no change in the rates of utilization of hospice care among Black and Latino patients.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Culture on End-of-Life Decision Making

Bullock

2011

Journal of Social Work in End-Of-Life & Palliative Care

164

174

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In their research, scholars have documented racial and ethnic differences in end-of-life care preferences, which have translated into cultural barriers. However, few studies have explained the racial differences. In the present study, focus groups with semi-structured follow-up interviews were utilized to elicit explanations for variance in decision making in a sample of Black and White community-dwelling residents. Participants identified specific cultural beliefs, values, and communication patterns that can be used to promote cultural competency among practitioners who provide care at end of life.

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“…Additionally, these studies 11,12 do not evaluate whether geographic access to hospice differs across communities that vary in racial/ethnic composition, income, and education, which are known to be related to hospice use. [3][4][5][6][7][8][9][10] Furthermore, existing studies 11,12 do not evaluate statespecific Certificate of Need (CON) policies for hospice, which were designed to manage the supply of hospices within a state and thus may be related to geographic access to hospice.…”

Section: Introductionmentioning

confidence: 99%

“…1 However, only 39% of decedents in the United States in 2008 received hospice care 2 and there is persistent evidence of disparities in hospice use by race/ethnicity, [3][4][5][6][7][8][9] income, 4-7,10 and education. 5,7,10 Given that more than 90% of hospice care involves staff making home visits 1 and hospice staff visit multiple homes in a given day, proximity to a hospice is important in ensuring access to these services.…”

Section: Introductionmentioning

confidence: 99%