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. 2018 Feb;66(2):407-413.
doi: 10.1111/jgs.15228. Epub 2017 Dec 18.

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

Jessica Rizzuto  1 , Melissa D Aldridge  1
Affiliations

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

Jessica Rizzuto et al. J Am Geriatr Soc. 2018 Feb.

Abstract

Objectives: To determine whether there is racial variation in hospice enrollees in rates of hospitalization and hospice disenrollment and, if so, whether systematic differences in hospice provider patterns explain the variation.

Design: Longitudinal cohort study.

Setting: Hospice.

Participants: Medicare beneficiaries (N = 145,038) enrolled in a national random sample of hospices (N = 577) from the National Hospice Survey and followed until death (2009-10).

Measurements: We used Medicare claims data to identify hospital admissions, emergency department (ED) visits, and hospice disenrollment after hospice enrollment. We used a series of hierarchical models including hospice-level random effects to compare outcomes of blacks and whites.

Results: In unadjusted models, black hospice enrollees were significantly more likely than white enrollees to be admitted to the hospital (14.9% vs 8.7%, odds ratio (OR) = 1.84, 95% confidence interval (CI) = 1.74-1.95), visit the ED (19.8% vs 13.5%, OR = 1.58, 95% CI = 1.50-1.66), and disenroll from hospice (18.1% vs 13.0%, OR = 1.48, 95% CI = 1.40-1.56). These results were largely unchanged after accounting for participant clinical and demographic covariates and hospice-level random effects. In adjusted models, blacks were at higher risk of hospital admission (OR = 1.75, 95% CI = 1.64-1.86), ED visits (OR = 1.61, 95% CI = 1.52-1.70), and hospice disenrollment (OR = 1.54, 95% CI = 1.45-1.63).

Conclusion: 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.

Keywords: end of life care; hospice; race disparities.

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Figures

Figure 1
Figure 1. Hospital Utilization and Hospice Disenrollment among Hospice Patients by Decile of Hospice Treatment Intensity
We grouped hospices into deciles arrayed from hospices with the lowest to highest rates of hospital admission (A), Emergency Department visits (B), and hospice disenrollment (C). Each panel compares the percent of black and white patients with each outcome in each decile. Error bars represent 95 percent confidence intervals around the decile rate estimate.
Figure 2
Figure 2
Unadjusted Differences in Hospital Utilization and Hospice Disenrollment between Black and White Patients
See this image and copyright information in PMC

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