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

增加老年非裔美国人获得临终关怀的机会：一项全国研究

• 批准号: 8665854
• 负责人: KIMBERLY S. JOHNSON
• 金额: $ 23.53万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8665854
• 关键词: Address; Admission activity; African; African American; Area; Caring; Certification; Characteristics; Chronic Disease; Church; Communication; Communities; Community Outreach; County; Data; Development; Early Diagnosis; Education and Outreach; Enrollment; Expert Opinion; Face; Family; Goals; Health Services Accessibility; Healthcare; Healthcare Market; Hospice Care; Improve Access; Individual; Intervention; Interview; Life Cycle Stages; Literature; Marketing; Medicare; Minority Groups; Modeling; Organizational Culture; Organizational Objectives; Outcome; Pain management; Palliative Care; Patient Care; Patients; Policies; Professional Organizations; Provider; Quality of Care; Reporting; Research; Sampling; Services; Solutions; Strategic Planning; Structure; Surveys; System; Training; Variant; Vulnerable Populations; Work; base; beneficiary; demographics; design; disorder prevention; effective intervention; end of life; experience; health disparity; hospice environment; improved; mortality; patient oriented; satisfaction; symptom management; therapy development

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.

描述(由申请人提供)：非裔美国人在获得医疗保健和质量方面的差距是有据可查的，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末期经历低质量的护理，包括疼痛管理不足和提供者沟通不畅，并报告对临终护理质量的总体满意度较低。此外，患有晚期疾病的老年非裔美国人比白人不太可能参加临终关怀，临终关怀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，以及缩小白人和非裔美国人在临终关怀质量方面的差距。因此，增加老年非裔美国人对临终关怀的使用可能会导致对这一弱势群体进行高质量、以患者为中心的临终关怀的可能性更大。像其他健康差异研究一样，关于临终关怀使用中的种族差异的大部分文献都集中在记录问题上，而不是寻找解决方案。确定可能影响临终关怀使用的可修改因素的经验性研究很少。初步工作表明，临终关怀提供者可能是干预措施的一个目标，以增加老年非裔美国人获得临终关怀的机会。除了对医疗保险认证的要求之外，个别临终关怀提供者的做法和政策也存在很大差异，而且各临终关怀服务领域登记参加临终关怀的联邦医疗保险受益人的比例存在巨大差异，这支持了这一想法。这种差异在非裔美国人中甚至更大，不能用人口统计学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距的重要决定因素，但许多关于组织因素的文献与 非裔美国人对临终关怀的使用包括对应该奏效的策略(即基于社区的伙伴关系)的专家意见，但还没有受到良好控制的分析试图确定这些策略中的哪些在哪些情况下效果最好。该项目的总体目标是确定临终关怀提供者的可修改做法，这些做法与老年非裔美国人在其服务领域更多地使用临终关怀有关。通过对全国临终关怀提供者样本的调查和定性访谈，这项研究的具体目标将审查招生政策、社区外展做法和其他组织特征之间的联系，例如临终关怀提供者的员工多样性、目标和战略规划，以及在其服务领域为老年非裔美国人提供服务。了解哪些组织做法与非裔美国人更多地使用临终关怀有关，将有助于制定干预措施，以增加获得临终关怀的机会，并提高临终关怀的质量。