Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun;39(6):619-632.
doi: 10.1177/10499091211034383. Epub 2021 Jul 28.

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Lauren T Starr  1 , Connie M Ulrich  1   2 , G Adriana Perez  1 , Subhash Aryal  3 , Paul Junker  4 , Nina R O'Connor  2   4 , Salimah H Meghani  1
Affiliations

Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

Lauren T Starr et al. Am J Hosp Palliat Care. 2022 Jun.

Abstract

Background: Palliative care consultation to discuss goals-of-care ("PCC") may mitigate end-of-life care disparities.

Objective: To compare hospitalization and cost outcomes by race and ethnicity among PCC patients; identify predictors of hospice discharge and post-discharge hospitalization utilization and costs.

Methods: This secondary analysis of a retrospective cohort study assessed hospice discharge, do-not-resuscitate status, 30-day readmissions, days hospitalized, ICU care, any hospitalization cost, and total costs for hospitalization with PCC and hospitalization(s) post-discharge among 1,306 Black/African American, Latinx, White, and Other race PCC patients at a United States academic hospital.

Results: In adjusted analyses, hospice enrollment was less likely with Medicaid (AOR = 0.59, P = 0.02). Thirty-day readmission was less likely among age 75+ (AOR = 0.43, P = 0.02); more likely with Medicaid (AOR = 2.02, P = 0.004), 30-day prior admission (AOR = 2.42, P < 0.0001), and Black/African American race (AOR = 1.57, P = 0.02). Future days hospitalized was greater with Medicaid (Coefficient = 4.49, P = 0.001), 30-day prior admission (Coefficient = 2.08, P = 0.02), and Black/African American race (Coefficient = 2.16, P = 0.01). Any future hospitalization cost was less likely among patients ages 65-74 and 75+ (AOR = 0.54, P = 0.02; AOR = 0.53, P = 0.02); more likely with Medicaid (AOR = 1.67, P = 0.01), 30-day prior admission (AOR = 1.81, P = 0.0001), and Black/African American race (AOR = 1.40, P = 0.02). Total future hospitalization costs were lower for females (Coefficient = -3616.64, P = 0.03); greater with Medicaid (Coefficient = 7388.43, P = 0.01), 30-day prior admission (Coefficient = 3868.07, P = 0.04), and Black/African American race (Coefficient = 3856.90, P = 0.04). Do-not-resuscitate documentation (48%) differed by race.

Conclusions: Among PCC patients, Black/African American race and social determinants of health were risk factors for future hospitalization utilization and costs. Medicaid use predicted hospice discharge. Social support interventions are needed to reduce future hospitalization disparities.

Keywords: communication; end of life; goals of care; hospice; intensive care; palliative care; racial disparities.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: No conflicts to report.

References

    1. Institute of Medicine. Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: 2015. - PubMed
    1. Clark MA, Person SD, Gosline A, Gawande AA, Block SD. Racial and Ethnic Differences in Advance Care Planning: Results of a Statewide Population-Based Survey. J Palliat Med. 2018;21(8):1078–1085. - PubMed
    1. McAfee CA, Jordan TR, Sheu JJ, Dake JA, Kopp Miller BA. Predicting Racial and Ethnic Disparities in Advance Care Planning Using the Integrated Behavioral Model. Omega (Westport). 2017:30222817691286. - PubMed
    1. Sanders JJ, Robinson MT, Block SD. Factors Impacting Advance Care Planning among African Americans: Results of a Systematic Integrated Review. J Palliat Med. 2016;19(2):202–227. - PubMed
    1. Smith AK, McCarthy EP, Paulk E, et al. Racial and ethnic differences in advance care planning among patients with cancer: impact of terminal illness acknowledgment, religiousness, and treatment preferences. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008;26(25):4131–4137. - PMC - PubMed