Organizational Variability and Racial Disparities in Hospice Use

描述（由申请人提供）：我的目标是成为一名学术老年医学家，专注于减少临终关怀的差距。我已经通过完成健康科学硕士学位和研究研究可能影响老年非裔美国人使用临终关怀的文化态度和信仰，启动了这个职业计划。有了这个奖项，我将获得健康差异研究的额外培训。我的研究和职业发展计划将由具有临终关怀研究专业知识的导师监督，并与患有生命限制性疾病的非裔美国人的护理相关。与白人相比，非裔美国人在生命结束时更有可能经历质量差的医疗保健。此外，研究证明，老年非裔美国人使用临终关怀的比例较低。由于临终关怀是目前最有效的临终关怀模式，增加老年非裔美国人对临终关怀的使用可能会减少临终关怀中的种族差异。到目前为止，没有研究评估临终关怀机构的组织特征与其为老年非裔美国人和高加索人提供服务的差异之间的关联。本研究将检验这一假设，即临终关怀使用的种族差异与个别临终关怀机构的结构、方案和政策的变化有关。具体目标是：（1）描述临终关怀水平的差异，在服务老年非裔美国人和白人;（2）描述临终关怀水平的结构，程序和政策，可能会影响临终关怀的非裔美国人使用的变化;（3）确定组织特征，促进临终关怀的非裔美国人的使用。这项研究将包括：对医疗保险索赔数据的分析和整个北卡罗来纳州和南卡罗来纳州的临终关怀特征的综合数据库;以及对这两个州的临终关怀提供者的调查和定性访谈。这项工作的调查结果将告知组织层面的干预措施，以增加老年非裔美国人使用临终关怀，并消除整个生命过程中的种族差异的发展。简单的公共卫生声明：尽管一些慢性疾病的死亡率较高，但非裔美国人使用临终关怀服务的比率低于白人。这项研究将确定哪些临终关怀计划和做法可能会增加非洲裔美国人对临终关怀的使用。

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.