Organizational Variability and Racial Disparities in Hospice Use

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DESCRIPTION (provided by applicant): My goal is to become an academic geriatrician focused on reducing disparities in end-of-life care. I have already initiated this career plan through completion of a Master of Health Sciences and research examining cultural attitudes and beliefs which may impact hospice use by older African Americans. With this award, I would acquire additional training in health disparities research. My research and career development plan will be overseen by mentors with research expertise in end-of-life care and content expertise related to the care of African Americans with life-limiting illness. Compared to Caucasians, African Americans are more likely to experience poor quality healthcare at the end of life. Also, studies document lower rates of hospice use among older African Americans. Because hospice is currently the most effective model for care at the end of life, increasing hospice use by older African Americans may reduce racial disparities in end-of-life care. To date, no research has evaluated the association between the organizational characteristics of hospices and disparities in their service to older African Americans and Caucasians. This research will test the hypothesis that racial disparities in hospice use are associated with variability in the structure, programs, and policies of individual hospice agencies. The specific aims are to: (1) Describe hospice-level variability in disparities in service to older African Americans and Caucasians; (2) Describe hospice-level variability in structure, programs, and policies which may influence hospice use by African Americans; (3) Identify organizational characteristics that facilitate the use of hospice by African Americans. This research will include: an analysis of Medicare Claims Data and a comprehensive database of the characteristics of hospices throughout North and South Carolina; and a survey and qualitative interview with hospice providers in the two states. The findings of this work will inform the development of organizational-level interventions to increase hospice use by older African Americans and eliminate racial disparities throughout the life course. Plain public health statement: Despite higher mortality rates from a number of chronic illnesses, African Americans use hospice services at lower rates that Caucasians. This research will determine which hospice programs and practices may increase the use of hospice by African Americans.