Increasing Access to Hospice Care for Older African Americans: A National Study

描述（由申请人提供）：非裔美国人在医疗保健获取和质量方面的差异是有据可查的，不仅包括疾病预防、早期发现和适当治疗，还包括临终关怀。与白人相比，非裔美国人更有可能在生命结束时经历低质量的护理，包括疼痛管理不足和提供者沟通不良，并且报告对临终护理质量的总体满意度较低。此外，患有晚期疾病的年长非裔美国人比白人更不可能参加临终关怀，这是目前最全面的临终关怀模式。临终关怀登记与多个护理领域的改善有关，包括症状管理和提供者沟通，并减少白人和非裔美国人在临终关怀质量方面的差异。因此，增加老年非裔美国人临终关怀的使用可能会使这一弱势群体更有可能获得高质量、以患者为中心的临终关怀。与其他健康差异研究一样，许多关于临终关怀使用中的种族差异的文献都侧重于记录问题，而不是寻求解决方案。很少有实证研究确定可改变的因素，可能影响安宁疗护的使用。初步工作表明，临终关怀提供者可能是干预的一个目标，以增加老年非裔美国人获得临终关怀的机会。除了医疗保险认证的要求之外，个别安宁疗护提供者的实践和政策的显著差异，以及在安宁疗护服务领域中，参加安宁疗护的医疗保险受益人比例的巨大差异，都支持了这一观点。这种差异在非裔美国人中甚至更大，并且不能用死者的人口统计或医疗保健市场因素来解释。此外，尽管卫生保健组织文化越来越被认为是健康差异的重要决定因素，但许多关于组织因素的文献都与之相关

DESCRIPTION (provided by applicant): Disparities in healthcare access and quality are well-documented for African Americans and include not only disease prevention, early detection, and appropriate treatment but also end-of-life care. Compared to Whites, African Americans are more likely to experience poor quality care at the end of life, including inadequate pain management and poor provider communication, and to report lower overall satisfaction with the quality of end-of-life care. Also, older African Americans with advanced illness are less likely than Whites to enroll in hospice which is currently the most comprehensive model for the care of patients at the end-of-life. Hospice enrollment is associated with both improvements in multiple domains of care, including symptom management and provider communication, and reduced disparities between Whites and African Americans in the quality of end-of-life care. Therefore, increasing the use of hospice care by older African Americans may result in a greater likelihood of high quality, patient-centered end-of-life care for this vulnerable population. Like other healh disparities research, much of the literature on racial disparities in hospice use has focused on documenting the problem rather than seeking solutions. There is little empiric research identifying modifiable factors which may influence the use of hospice of care. Preliminary work suggests that hospice providers may be one target for interventions to increase access to hospice for older African Americans. This idea is supported by significant variability in the practices and policies of individual hospice providers beyond requirements for Medicare certification and the large variability across hospice service areas in the proportion of Medicare beneficiaries who enroll in hospice. This variability is even greater among African Americans and is not explained by decedent demographics or healthcare market factors. Additionally, although health care organizational culture is increasing being recognized as an important determinant of health disparities, much of the literature on organizational factors associated with the use of hospice by African Americans includes expert opinion of strategies that should work (i.e. community-based partnerships), but there have been no well- controlled analyses attempting to determine which of these strategies work best under which circumstances. The overall goal of this project is to identify modifiable practices of hospice providers that are associated with greater use of hospice care by older African Americans in their service area. Using a survey and qualitative interview of a national sample of hospice providers, the study's specific aims will examine the association between the admission policies, community outreach practices, and other organizational characteristics, such as staff diversity, goals and strategic planning of hospice providers and service to older African Americans in their service area. Understanding which organizational practices are associated with greater use of hospice by African Americans will inform the development of interventions to increase access to hospice care and improve the quality of end-of-life care.