Are Hospice Admission Practices Associated With Hospice Enrollment for Older African Americans and Whites?
Are Hospice Admission Practices Associated With Hospice Enrollment for Older African Americans and Whites?
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DOI：
10.1016/j.jpainsymman.2015.11.010
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发表时间：
2016-04-01
影响因子：
4.7
通讯作者：
Tulsky, James A.
中科院分区：
文献类型：
--
作者：
Johnson, Kimberly S.;Payne, Richard;Tulsky, James A.
上下文接受昂贵的姑息治疗的临终关怀可能会为更多的非洲裔美国人提供服务，因为他们更喜欢积极的临终关怀。检查临终关怀的录取做法和非裔美国人和白人的入学率之间的关联。这是一个横断面研究61北和南卡罗来纳州收容所。我们开发了一个临终关怀入院实践量表;分数越高，表明限制性实践越少，也就是说，临终关怀机构接纳接受化疗、正性肌力药物等治疗的患者的频率越高。在对每个种族群体的单独多变量分析中，我们检查了在其服务区域（2008年医疗保险数据）由临终关怀服务的死者（年龄>= 65岁）比例与入院实践之间的关系，同时控制医疗保健资源（例如，医院床位数）和市场集中度在地区、所有制、医疗机构等方面的差异。非营利收容所和那些有较大的预算报告较少限制入院的做法。在双变量分析中，在两个种族组中，入院限制较少的临终关怀机构为更大比例的患者提供服务（P < 0.001）。然而，在多变量模型中，非营利组织的所有权和更大的预算，而不是录取的做法预测的结果。预算较多的收容所在其服务区为更多的非裔美国人和白人提供服务。尽管较大的临终关怀医院报告的入院限制较少，但他们也可能提供了其他对患者（无论种族如何）都很重要的服务，例如更多的家庭支持或非医疗费用援助，并参加更多的外展活动，增加了他们的知名度和转诊基础。未来的研究应该探讨影响种族多样性老年人临终关怀登记决策的因素。(c)2016年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
Context. Hospices that enroll patients receiving expensive palliative therapies may serve more African Americans because of their greater preferences for aggressive end-of-life care.Objectives. Examine the association between hospices' admission practices and enrollment of African Americans and whites.Methods. This was a cross-sectional study of 61 North and South Carolina hospices. We developed a hospice admission practices scale; higher scores indicate less restrictive practices, that is, greater frequency with which hospices admitted those receiving chemotherapy, inotropes, and so forth. In separate multivariate analyses for each racial group, we examined the relationship between the proportion of decedents (age >= 65) served by a hospice in their service area (2008 Medicare Data) and admission practices while controlling for health care resources (e.g., hospital beds) and market concentration in the area, ownership, and budget.Results. Nonprofit hospices and those with larger budgets reported less restrictive admission practices. In bivariate analyses, hospices with less restrictive admission practices served a larger proportion of patients in both racial groups (P < 0.001). However, in the multivariate models, nonprofit ownership and larger budgets but not admission practices predicted the outcome.Conclusion. Hospices with larger budgets served a greater proportion of African Americans and whites in their service area. Although larger hospices reported less restrictive admission practices, they also may have provided other services that may be important to patients regardless of race, such as more in-home support or assistance with nonmedical expenses, and participated in more outreach activities increasing their visibility and referral base. Future research should explore factors that influence decisions about hospice enrollment among racially diverse older adults. (c) 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.