End-of-Life Hospitalization for African American and Non-Latino White Nursing Home Residents: Variation by Race and a Facility's Racial Composition

Mor, Vincent; Papandonatos, George; Miller, Susan C.

doi:10.1089/jpm.2005.8.58

Cited by 54 publications

(46 citation statements)

References 42 publications

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“…Kemle ( 1992Unspecified 19951987-1998 1992 and 1994 1994 1992-1997 1991-1994 1991-1994 1991-1994 1997 1996 1995-1998 1991-1993 2003-2004 1996-1997 1996-1997 2001-2003 1995-1996 1991-1993 2006 1991-1993 2001-2005 1996-1999 1995-1997 residents are more likely to be hospitalized (Barker et al, 1994;Carter, 2003a;Freiman & Murtaugh, 1993;Fried & Mor, 1997;Gordon et al, 1985;Mor, Papandonatos, & Miller, 2005). However, Carter (2003a) found that, conditional on hospitalization, males are not any more likely to be hospitalized for ACS conditions.…”

Section: Ackermann Andmentioning

confidence: 99%

“…However, in a study of hospitalization for suspected pneumonia, Konetzka et al (2004) found that African American females were more likely to be hospitalized. Mor et al (2005) reported that older African American residents and those with greater number of activities of daily living limitations were more likely to be hospitalized in the last 90 days of life. They further reported that White and Black residents in nursing homes with a greater proportion of Black residents were more likely to be hospitalized in their last 90 days compared to nursing homes with fewer Black residents, but they suggest that a higher percentage of African American residents may proxy for fewer nursing home resources that lead to lower quality care (Mor et al, 2005).…”

Section: Ackermann Andmentioning

confidence: 99%

“…C. Miller et al, 2001;Mor et al, 2005). Three of these studies indicate no statistically significant effects of advance directives on hospitalizations (Alessi & Harker, 1998;Fried & Mor, 1997;Lamberg et al, 2005), whereas others indicate that the presence of advance directives is associated with fewer hospitalizations (Fried et al, 1995;Gozalo & Miller, 2007;Intrator et al, 1999;Konetzka et al, 2004;S.…”

Section: Advance Directivesmentioning

confidence: 99%

“…Three of these studies indicate no statistically significant effects of advance directives on hospitalizations (Alessi & Harker, 1998;Fried & Mor, 1997;Lamberg et al, 2005), whereas others indicate that the presence of advance directives is associated with fewer hospitalizations (Fried et al, 1995;Gozalo & Miller, 2007;Intrator et al, 1999;Konetzka et al, 2004;S. C. Miller et al, 2001;Mor et al, 2005). Among short-stay residents, Hutt et al (2002) found that advance directives were predictive of fewer hospitalizations among short-stay residents with pneumonia but not urinary tract infections or chronic heart failure.…”

Section: Advance Directivesmentioning

confidence: 99%

“…Zimmerman et al (2002) studied nursing home patients with infection in Maryland between 1992 and 1995 and found evidence that the risk of hospitalization was higher for residents of FP homes and chain-affiliated homes. However, Mor et al (2005) found conflicting evidence on profit status and hospitalizations. In their study, residents near death residing in FP nursing homes in New York were more likely to be hospitalized, but they found no association between profit status and risk of hospitalization among similar patients in Mississippi (Mor et al, 2005).…”

Section: Financial Implications Profit Status and Chain Affiliationmentioning

confidence: 99%

See 4 more Smart Citations

Predictors of Nursing Home Hospitalization

Grabowski

Stewart

Broderick³

et al. 2007

Med Care Res Rev

223

236

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Hospitalization of nursing home residents is costly and potentially exposes residents to iatrogenic disease and psychological harm. This article critically reviews the association between the decision to hospitalize and factors related to the residents' welfare and preferences, the providers' attitudes, and the financial implications of hospitalization. Regarding the resident's welfare, factors associated with hospitalization included sociodemographics, health characteristics, nurse staffing, the presence of ancillary services, and the use of hospices. Patient preferences (e.g., advance directives) and provider attitudes (e.g., overburdening of staff) were also associated with increased hospitalization. Finally, financial variables related to hospitalization included nursing home ownership status and state Medicaid policies, such as nursing home payment rates and bed-hold requirements. Most studies relied on potentially confounded research designs, which leave open the issue of selection bias. Nevertheless, the existing literature asserts that nursing home hospitalizations are frequent, often preventable, and related to facility practices and state Medicaid policies.

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Section: Ackermann Andmentioning

confidence: 99%

Section: Ackermann Andmentioning

confidence: 99%

Section: Advance Directivesmentioning

confidence: 99%

Section: Advance Directivesmentioning

confidence: 99%

Section: Financial Implications Profit Status and Chain Affiliationmentioning

confidence: 99%

See 3 more Smart Citations

Predictors of Nursing Home Hospitalization

Grabowski

Stewart

Broderick³

et al. 2007

Med Care Res Rev

223

236

View full text Add to dashboard Cite

show abstract

Shifting Place of Death Among Children With Complex Chronic Conditions in the United States, 1989-2003

Feudtner¹,

Feinstein²,

Satchell³

et al. 2007

JAMA

212

165

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Potentially Avoidable Hospitalizations Among Historically Marginalized Nursing Home Residents

Estrada,

Barcelona,

Dhingra

et al. 2024

JAMA Netw Open

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ImportanceNursing home (NH) transfers to hospitals are common and have been associated with cognitive decline; approximately 45% of NH hospital transfers are potentially avoidable hospitalizations (PAHs).ObjectiveTo determine PAH incidence for historically marginalized NH residents with severe cognitive impairment compared with non-Hispanic White residents.Design, Setting, and ParticipantsThis cross-sectional study merged 2018 Centers for Medicaid &amp; Medicare Services datasets and LTCFocus, a public dataset on US NH care, for US NH residents aged 65 years and older who had a hospitalization. Analyses were performed from January to May 2022.ExposureRace and ethnicity of NH residents.Main Outcomes and MeasuresRacial and ethnic differences in resident-level annual rates of PAHs were estimated for residents with and without severe cognitive impairment (measured using the Cognitive Function Scale), controlling for resident characteristics, comorbidities, dual eligibility, and time at risk. PAHs were defined as NH hospital transfers that resulted from neglectful NH care or for which NH treatment would have been appropriate.ResultsOf 2 098 385 NH residents nationwide included in the study, 7151 (0.3%) were American Indian or Alaska Native, 39 873 (1.9%) were Asian, 229 112 (10.9%) were Black or African American, 99 304 (4.7%) were Hispanic, 2785 (0.1%) were Native Hawaiian or Pacific Islander, 1 713 670 (81.7%) were White, and 6490 (0.3%) were multiracial; 1 355 143 (64.6%) were female; 128 997 (6.2%) were severely cognitively impaired; and the mean (SD) age was 81.8 (8.7) years. PAH incidence rate ratios (IRRs) were significantly greater for residents with severe cognitive impairment compared with those without. In unadjusted analyses comparing historically marginalized residents with severe cognitive impairment vs non-Hispanic White residents with severe cognitive impairment, American Indian or Alaska Native residents had a 49% higher PAH incidence (IRR, 1.49 [95% CI, 1.10-2.01]), Black or African American residents had a 64% higher incidence (IRR, 1.64 [95% CI, 1.48-1.81]), and Hispanic residents had a 45% higher incidence (IRR, 1.45 [95% CI, 1.29-1.62]). Higher incidences persisted for historically marginalized residents with severe cognitive impairment vs non-Hispanic White residents with severe cognitive impairment in adjusted analyses. Asian residents had a 24% higher PAH incidence (IRR, 1.24 [95% CI, 1.06-1.45]), Black or African American residents had a 48% higher incidence (IRR, 1.48 [95% CI, 1.36-1.60]), and Hispanic residents had a 27% higher incidence (IRR, 1.27 [95% CI, 1.16-1.39]).Conclusions and RelevanceIn this cross-sectional study of PAHs, compared with non-Hispanic White NH residents, historically marginalized residents had increased PAH incidence. In the presence of severe cognitive impairment, incidence rates increased significantly compared with rates for residents without severe cognitive impairment. These results suggest that identification of residents with severe cognitive impairment and proper NH care may help prevent further cognitive decline by avoiding PAHs.

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End-of-Life Hospitalization for African American and Non-Latino White Nursing Home Residents: Variation by Race and a Facility's Racial Composition

Abstract: It appears higher end-of-life hospitalization rates for African American residents are attributable to the facilities where most reside, and to differential hospitalization of older or more functional limited residents.

Cited by 54 publications

References 42 publications

Predictors of Nursing Home Hospitalization

Predictors of Nursing Home Hospitalization

Shifting Place of Death Among Children With Complex Chronic Conditions in the United States, 1989-2003

Potentially Avoidable Hospitalizations Among Historically Marginalized Nursing Home Residents

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