Racial Disparities in Hospice Outcomes: A Race or Hospice‐Level Effect?

Rizzuto, Jessica; Aldridge, Melissa D.

doi:10.1111/jgs.15228

Cited by 46 publications

(30 citation statements)

References 37 publications

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“…Racial and ethnic disparities in utilization were observed in unadjusted tests but not in adjusted models. Although black and Hispanic individuals are less likely to enroll in hospice, disparities may be explained by other sociodemographic factors, such as economic status, geography, and education. These factors warrant additional study to fully understand whether, and how, minority populations are underserved at the end of life.…”

Section: Discussionmentioning

confidence: 99%

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Cagle

Lee

Ornstein

et al. 2019

J American Geriatrics Society

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OBJECTIVES Reliable national estimates of hospice use and underuse are needed. Additionally, drivers of hospice use in the United States are poorly understood, especially among noncancer populations. Thus the objectives of this study were to (1) provide reliable estimates of hospice use among adults in the United States; and (2) identify factors predicting use among decedents and within subsamples of cancer and noncancer deaths. DESIGN We conducted a prospective cohort study using the Health and Retirement Study survey. Excluding sudden deaths, we used data from the 2012 survey wave to predict hospice use in general, and then separately for cancer and non‐cancer deaths. SETTING Study data were provided by a population‐based sample of older adults from the U.S. PARTICIPANTS We constructed a sample of 1,209 participants who died between the 2012 and 2014 survey waves. MEASUREMENTS Hospice utilization was reported by proxy. Exposure variables included demographics, functionality (activities of daily living [ADLs]), health, depression, dementia, advance directives, nursing home residency, and cause of death. RESULTS Hospice utilization rate was 52.4% for the sample with 70.8% for cancer deaths and 45.4% for noncancer deaths. Fully adjusted model results showed being older (odds ratio [OR] = 1.54), less healthy (OR = .79), having dementia (OR = 1.52), and having cancer (OR = 5.47) were linked to greater odds of receiving hospice. Among cancer deaths, being older (OR = 1.64) and female (OR = 2.54) were the only predictors of hospice use. Among noncancer deaths, increased age (OR = 1.58), more education (OR = 1.56), being widowed (OR = 1.55), needing help with ADLs (OR = 1.13), and poor health (OR = .77) were associated with hospice utilization. CONCLUSION Findings suggest hospice remains underutilized, especially among individuals with noncancer illness. Extrapolating results to the US population, we estimate that annually nearly a million individuals who are likely eligible for hospice die without its services. Most (84%) of these decedents have a noncancer condition. Interventions are needed to increase appropriate hospice utilization, particularly in noncancer care settings. J Am Geriatr Soc 68:783–793, 2020

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Section: Discussionmentioning

confidence: 99%

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Cagle

Lee

Ornstein

et al. 2019

J American Geriatrics Society

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show abstract

“…15 Although these results concur with prior studies of general hospice patient populations, 2,5,16 reasons for this disparity are unclear and not linked to hospice-level effects. 37 One explanation is that African American and Hispanic hospice patients receive systematically different care than non-Hispanic whites. However, supplementary analyses revealed no significant racial/ethnic differences in service use among PWD discharged alive.…”

Section: Discussionmentioning

confidence: 99%

Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia

Luth

Russell

Brody

et al. 2019

J American Geriatrics Society

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OBJECTIVES The end‐of‐life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia. DESIGN Retrospective cohort study. SETTING A large not‐for‐profit agency in New York City. PARTICIPANTS A total of 2629 hospice patients with dementia age 65 years and older. MEASUREMENTS Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits). RESULTS Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI] = 1.34‐4.38; Hispanic: aOR = 2.99; 95% CI = 1.81‐4.94). Home hospice (aOR = 7.57; 95% CI = 4.04‐14.18), longer length of service (aOR = 1.04; 95% CI = 1.04‐1.05), and more days between nurse visits and discharge (aOR = 1.86; 95% CI = 1.56‐2.21) were also associated with live discharge. CONCLUSION To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end‐of‐life trajectory of patients with dementia. J Am Geriatr Soc 68:551–558, 2020

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“…However, within a particular hospice, Black and Hispanic people receive care that is similar to that of White people (Price, Parast, Haas, Teno, & Elliott, 2017). In contrast, another study found disparities existed between the quality of care for Black and White people within the same hospice setting (Rizzuto & Aldridge, 2018). Barclay et al (2013) found Black people enrolled in hospice were also less likely to die at home compared with White people even when accounting for other socioeconomic factors such as income, location, and education.…”

Section: Discussionmentioning

confidence: 99%

Closing the Gap in Hospice Utilization for the Minority Medicare Population

Hughes

Vernon

2019

Gerontology and Geriatric Medicine

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Background: Medicare spends about 20% more on the last year of life for Black and Hispanic people than White people. With lower hospice utilization rates, racial/ethnic minorities receive fewer hospice-related benefits such as lesser symptoms, lower costs, and improved quality of life. For-profit hospices have higher dropout rates than nonprofit hospices, yet target racial/ethnic minority communities more through community outreach. This analysis examined the relationship between hospice utilization and for-profit hospice status and conducted an economic analysis of racial/ethnic minority utilization. Method: Cross-sectional analysis of 2014 Centers for Medicare & Medicaid Services (CMS), U.S. Census, and Hospice Analytics data. Measures included Medicare racial/ethnic minority hospice utilization, for-profit hospice status, estimated cost savings, and several demographic and socioeconomic variables. Results: The prevalence of for-profit hospices was associated with significantly increased hospice utilization among racial/ethnic minorities. With savings of about $2,105 per Medicare hospice enrollee, closing the gap between the White and racial/ethnic minority populations would result in nearly $270 million in annual cost savings. Discussion: Significant disparities in hospice use related to hospice for-profit status exist among the racial/ethnic minority Medicare population. CMS and state policymakers should consider lower racial/ethnic minority hospice utilization and foster better community outreach at all hospices to decrease patient costs and improve quality of life.

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Racial Disparities in Hospice Outcomes: A Race or Hospice‐Level Effect?

Abstract: Racial differences in intensity of care at the end of life are not attributable to hospice-level variation in intensity of care. Differences in patterns of care between black and white hospice enrollees persist within the same hospice.

Cited by 46 publications

References 37 publications

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths

Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia

Closing the Gap in Hospice Utilization for the Minority Medicare Population

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