Racial Differences in Health Care Transitions and Hospice Use at the End of Life

Abstract

Background: Although the fragmentation of end-of-life care has been well documented, previous research has not examined racial and ethnic differences in transitions in care and hospice use at the end of life. Design and Subjects: Retrospective cohort study among 649,477 Medicare beneficiaries who died between July 2011 and December 2011. Measurements: Sankey diagrams and heatmaps to visualize the health care transitions across race/ethnic groups. Among hospice enrollees, we examined racial/ethnic differences in hospice use patterns, including length of hospice enrollment and disenrollment rate. Results: The mean number of care transitions within the last six months of life was 2.9 transitions (standard deviation [SD] = 2.7) for whites, 3.4 transitions (SD = 3.2) for African Americans, 2.8 transitions (SD = 3.0) for Hispanics, and 2.4 transitions (SD = 2.7) for Asian Americans. After adjusting for age and sex, having at least four transitions was significantly more common for African Americans (39.

Disparities in Palliative and Hospice Care and Completion of Advance Care Planning and Directives Among Non-Hispanic Blacks: A Scoping Review of Recent Literature

“…Non-Hispanic Black patients experience the highest number of transitions, indicating serious integration issues that must be resolved. 16 Another recent study documented that compared with non-Hispanic White hospice patients with dementia, non-Hispanic Blacks patients with dementia experienced increased risk of live discharge. 177 A qualitative study conducted with non-Hispanic Black patients and lay caregivers receiving hospice care services found additional barriers to hospice enrollment, including 1) inconsistent health care access associated with economic enabling factors; 2) poor communication with providers and perceived experiences of discrimination by the health care system; 3) the bureaucratic difficulty of receiving reimbursement under the Medicare hospice benefit; and 4) the perception that hospice care is a way to abdicate responsibilities or to hasten a person's death.…”

“…After searching almost fourthly-thousand citations, 284 articles were included in our study, of which 147 were manuscripts that directly addressed end-of-life and hospice care, palliative care, as well as advance care planning and directives that include non-Hispanic Blacks. 4 …”

“…Non-Hispanic Black patients experience the highest number of transitions, indicating serious integration issues that must be resolved. 16 Another recent study documented that compared with non-Hispanic White hospice patients with dementia, non-Hispanic Blacks patients with dementia experienced increased risk of live discharge. 177 …”

Associations Between Health Literacy and End-of-Life Care Intensity Among Medicare Beneficiaries

“…Drawing upon previous literature, 4,5,16,21 we included patient demographics, clinical characteristics, and area-level socioeconomic characteristics as covariates. Patient demographics included age (categorized as 66-69 years, 70-74 years, 75-79 years, 80-84 years, and 85 years), gender, and race/ethnicity (non-Hispanic white, black, Hispanic, and other).…”

Disparities in end-of-life care, expenditures, and place of death by health insurance among cancer patients in China: a population-based, retrospective study

“…China ranked in the last quartile of countries worldwide on the quality of death, according to the 2015 Quality of Death Index proposed by the Economist Intelligence Unit [ 7 ]. With the increasing number of cancer survivors, the disparities in access to EOL care and the intensity of EOL healthcare utilization have been widely debated [ 9 , 10 ]. Several randomized trials among end-stage cancer patients showed that earlier palliative care could lead to improved quality of life and less aggressive care [ 11 , 12 ].…”