Racial Differences in Hospice Use and In-Hospital Death Among Medicare and Medicaid Dual-Eligible Nursing Home Residents

Kwak, Jung; Haley, William E.; Chiriboga, David A.

doi:10.1093/geront/48.1.32

Cited by 60 publications

(97 citation statements)

References 32 publications

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“…These disparities are likely indicative of variations in physician knowledge of, familiarity with, and perspectives regarding hospice. Consistent with this, there are well-documented, widespread variations in patients' perceptions and usage of hospice, 19,[49][50][51][52][53][54] with recent work also identifying such disparities among physicians. 55,56 Given the widely accepted benefits of hospice, our findings suggest significant discrepancies among physicians in providing quality end-of-life care to patients with advanced cancer.…”

Section: Discussionmentioning

confidence: 70%

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Wang

Knight

Evans

et al. 2017

JOP

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Purpose: The benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use. Methods: We conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists. Results: Of 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P < .01). In addition, there was dramatic variation in median LOS by individual physician (range, 4 to 88 days for physicians with five or more patients), indicating differences in hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population. Conclusion: Nearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.

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Section: Discussionmentioning

confidence: 70%

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Wang

Knight

Evans

et al. 2017

JOP

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“…[1][2][3][4][5][6][7] Differences in perceptions hospice quality have also been identified. In a prior study of the 2005 Family Evaluation of Hospice Care (FEHC) Survey, bereaved family members of African American (AA) patients were more likely to have one or more concerns along certain patient and family-centered domains of care, including pain management, treatment of dyspnea, and provision of emotional support.…”

Section: Introductionmentioning

confidence: 99%

African American Bereaved Family Members' Perceptions of Hospice Quality: Do Hospices with High Proportions of African Americans Do Better?

Rhodes

Liu

Halm

2012

Journal of Palliative Medicine

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Background: Research suggests that racial differences in end-of-life care persist even among patients enrolled in hospice.Objective: The objective of the study was to examine the association between bereaved family members' satisfaction with hospice services and the proportion of African American (AA) patients in hospice. Methods: The 2007 and 2008 Family Evaluation of Hospice Care (FEHC) Survey examined family members' perceptions of the quality of care on several dimensions including: unmet need for pain, dyspnea, and emotional support; being informed about the patient's condition and what to expect as the patient was dying; being informed about medications and treatments for symptoms; coordination of care; and overall satisfaction with care. We examined the association between family members' perception along each domain and the proportion of AAs served by hospices surveyed. Results: Of the 11,892 AA decedents in 678 hospice programs, 53.7% were female. The leading cause of death was cancer (51.6%). On univariate analysis, family members of decedents who died in hospices that had higher proportions of AAs were less likely to have concerns about unmet pain needs (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.72-0.98), more likely to have concerns about coordination of care (1.28, 1.17-1.40), and less likely to perceive care as excellent or very good (0.73, 0.63-0.84). Coordination-of-care concerns and lower overall rating of care persisted in multivariable analyses. There were no other significant associations between family perceptions and proportions of AAs in hospice. Conclusions: Among hospices with higher proportions of AAs, family members have more concerns about coordination of care and have lower overall perceptions of quality.

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“…As both a humane way to provide a dignified death and a cost-saving option for end-of-life care, future policy should continue strive to improve funding for and access to hospice services (Carlson, Morrison, & Bradley, 2008). Low socioeconomic, rural, minority, and older patients are unfortunately underrepresented in hospice utilization (Ahmed et al, 2004;Casey, Moscovice, Virnig, & Durham, 2005;Kwak, Haley, & Chiriboga, 2008), and only 25% of patients overall who qualify for hospice care actually enroll (Eues, 2007).…”

Section: Discussionmentioning

confidence: 99%

Informal Hospice Caregiving: The Toll on Quality of Life

Wilder

Demiris

et al. 2008

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

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Racial Differences in Hospice Use and In-Hospital Death Among Medicare and Medicaid Dual-Eligible Nursing Home Residents

Cited by 60 publications

References 32 publications

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

Variations Among Physicians in Hospice Referrals of Patients With Advanced Cancer

African American Bereaved Family Members' Perceptions of Hospice Quality: Do Hospices with High Proportions of African Americans Do Better?

Informal Hospice Caregiving: The Toll on Quality of Life

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