Hospice care outcomes, such as hospital readmissions and hospice disenrollment, is cut along racial lines, new research indicates.

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- Racial disparities exist for patients in hospice care outcomes, as African American patients experience higher emergency department utilization, readmission, and hospice disenrollment rates than their white counterparts, according to recent research from the Icahn School of Medicine at Mount Sinai Hospital.

In an analysis of over 550 hospices across the country, lead researcher Melissa Aldridge, PhD, MBA, found that African American patients were far more likely to be admitted into the hospital during hospice care.

“We found that black hospice patients were significantly more likely than white hospice patients to be admitted to the hospital, to go to the emergency room, and to disenroll from hospice prior to death,” said Aldridge, who is also an associate professor and vice chair for research in geriatrics and palliative medicine at the Icahn School of Medicine. “These patterns remained after accounting for patient illness, demographics, and type of hospice from which these patients received care.”

In total, black hospice patients saw 14.9 percent hospital admission rates, compared to 8.7 percent for white patients. Nearly 20 percent of black patients visited the emergency room compared to only 13.5 percent of white patients, and 18.1 percent of black patients disenrolled from hospice prior to death compared to 13 percent of white patients.

“These higher rates of emergency department use, hospital admission, and hospice disenrollment by blacks compared with whites were attributable to racial differences within hospices rather than systemic differences between hospices in these outcomes,” Aldridge said.

These outcomes are troubling because they are contrary to the fundamental purpose of hospice care, asserted Aldridge and her research collaborator, Jessica Rizzuto, MPP, a student at the Icahn School of Medicine.

Patients utilize hospice care during serious or terminal illness so they can receive care at home and experience a higher quality of life. Admission into the hospital or emergency department usually results in the patient receiving a higher intensity of care that will likely not make a difference in a terminal prognosis.

These racial disparities mean that some demographics have a higher likelihood of experience poorer quality of life than others.

The pair did not offer a data-driven explanation as to why African American patients experience more hospital care at the end of life, but it is worth pointing out that the study demographics skewed 8 percent black and 92 percent white. In general, black patients do not reap the benefits of hospice care as often as their white peers.

Aldridge and Rizzuto also hypothesized some reasons as to why black patients experience more hospitalizations during hospice care. Patient and family preferences for care, patient-provider communication about the purpose of hospice care, and availability of hospice resources all served as potential explanations for the study’s results.

Ultimately, these results point to a need for further research, Aldridge and Rizzuto said. Healthcare professionals must better understand these cultural differences and disparities to begin working on closing gaps in care and understanding.

“Our findings underscore the need to better understand racial disparities in outcomes after hospice enrollment,” Aldridge stated. “Culturally sensitive interventions that increase understanding of hospice, address shortcomings in provider communication, and improve caregiver resources could help decrease these persistent differences in outcomes.”

Separate research has indicated that longer duration of hospice care is the key to patient satisfaction at the end of life. A 2017 study published in the Journal of Clinical Oncology found that patients utilizing hospice care received better treatment at the end of life.

For example, 91 percent of hospice patients reported receiving pain management medications, compared to 81 percent of patients not receiving hospice care. Family caregivers were also able to see the difference in end-of-life care quality in the hospice setting. Eighty percent of family members said their loved ones received “just the right amount” of pain management, compared to 73 percent of non-hospice patients.

“Patients with advanced cancer often experience pain, dyspnea, and distress at the end of life (EOL), and use intensive, hospital-based services near death,” the researchers concluded. “Hospice offers an alternative, patient-centered model of care focused on relieving suffering, and often delivers services within the home environment.”

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