| Racial disparities in in-hospital death and hospice use among nursing home residents at the end of life. | |
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MedLine Citation:
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PMID: 22002648 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Significant racial disparities have been reported regarding nursing home residents' use of hospital and hospice care at the end of life (EOL). OBJECTIVE: To examine whether the observed racial disparities in EOL care are due to within-facility or across-facility variations. RESEARCH DESIGN AND SUBJECTS: Cross-sectional study of 49,048 long-term care residents (9.23% black and 90.77% white) in 555 New York State nursing homes who died during 2005-2007. The Minimum Data Set was linked with Medicare inpatient and hospice claims. MEASURES: In-hospital death determined by inpatient claims and hospice use determined by hospice claims. For each outcome, risk factors were added sequentially to examine their partial effects on the racial differences. Hierarchical models were fit to test whether racial disparities are due to within-facility or across-facility variations. RESULTS: 40.33% of blacks and 24.07% of whites died in hospitals; 11.55% of blacks and 17.39% of whites used hospice. These differences are partially due to disparate use of feeding tubes, do-not-resuscitate and do-not-hospitalize orders. We find no racial disparities in in-hospital death [odds ratio (OR) of race=0.95; 95% confidence interval (CI), 0.87-1.04] or hospice use (OR of race=0.90, 95% CI, 0.79-1.02) within same facilities. Living in facilities with 10% more blacks increases the odds of in-hospital death by 22% (OR=1.22, 95% CI, 1.17-1.26) and decreases the odds of hospice use by 15% (OR=0.85, 95% CI, 0.78-0.94). CONCLUSIONS: Differential use of feeding tubes, do-not-resuscitate and do-not-hospitalize orders lead to racial differences in in-hospital death and hospice use. The remaining disparities are primarily due to overall EOL care practices in predominately black facilities, not to differential hospitalization and hospice-referral patterns within facilities. |
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Authors:
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Nan Tracy Zheng; Dana B Mukamel; Thomas Caprio; Shubing Cai; Helena Temkin-Greener |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Medical care Volume: 49 ISSN: 1537-1948 ISO Abbreviation: Med Care Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-10-18 Completed Date: 2011-12-13 Revised Date: 2013-02-19 |
Medline Journal Info:
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Nlm Unique ID: 0230027 Medline TA: Med Care Country: United States |
Other Details:
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Languages: eng Pagination: 992-8 Citation Subset: IM |
Affiliation:
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Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. Nan_Zheng@urmc.rochester.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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African Continental Ancestry Group
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statistics & numerical data Aged Aged, 80 and over Confidence Intervals Continental Population Groups / statistics & numerical data* Cross-Sectional Studies Enteral Nutrition / statistics & numerical data European Continental Ancestry Group / statistics & numerical data Female Healthcare Disparities / statistics & numerical data* Hospice Care / statistics & numerical data* Hospital Mortality* Humans Logistic Models Male New York / epidemiology Nursing Homes / statistics & numerical data Odds Ratio Resuscitation Orders Risk Factors Terminal Care / statistics & numerical data* |
| Grant Support | |
ID/Acronym/Agency:
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R01 AG023077-01A2/AG/NIA NIH HHS; R01 AG023077-02/AG/NIA NIH HHS; R01 AG023077-03/AG/NIA NIH HHS; R01 AG023077-04/AG/NIA NIH HHS; R01 NR010727-01A1/NR/NINR NIH HHS; R01 NR010727-02/NR/NINR NIH HHS; R01 NR010727-03/NR/NINR NIH HHS; R01 NR010727-04/NR/NINR NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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