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Hospice Quality, Race, and Disenrollment in Hospice Enrollees With Dementia.
Hunt, Lauren J; Gan, Siqi; Smith, Alexander K; Aldridge, Melissa D; Boscardin, W John; Harrison, Krista L; James, Jennifer E; Lee, Alexandra K; Yaffe, Kristine.
Afiliación
  • Hunt LJ; Department of Physiological Nursing, University of California, San Francisco, San Francisco, California, USA.
  • Gan S; Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA.
  • Smith AK; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA.
  • Aldridge MD; Northern California Institute for Research and Education, San Francisco, California, USA.
  • Boscardin WJ; Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
  • Harrison KL; Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
  • James JE; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  • Lee AK; Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
  • Yaffe K; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
J Palliat Med ; 26(8): 1100-1108, 2023 08.
Article en En | MEDLINE | ID: mdl-37010377
Background: Racial and ethnic minoritized people with dementia (PWD) are at high risk of disenrollment from hospice, yet little is known about the relationship between hospice quality and racial disparities in disenrollment among PWD. Objective: To assess the association between race and disenrollment between and within hospice quality categories in PWD. Design/Setting/Subjects: Retrospective cohort study of 100% Medicare beneficiaries 65+ enrolled in hospice with a principal diagnosis of dementia, July 2012-December 2017. Race and ethnicity (White/Black/Hispanic/Asian and Pacific Islander [AAPI]) was assessed with the Research Triangle Institute (RTI) algorithm. Hospice quality was assessed with the publicly-available Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey item on overall hospice rating, including a category for hospices exempt from public reporting (unrated). Results: The sample included 673,102 PWD (mean age 86, 66% female, 85% White, 7.3% Black, 6.3% Hispanic, 1.6% AAPI) enrolled in 4371 hospices nationwide. Likelihood of disenrollment was higher in hospices in the lowest quartile of quality ratings (vs. highest quartile) for both White (adjusted odds ratio [AOR] 1.12 [95% confidence interval 1.06-1.19]) and minoritized PWD (AOR range 1.2-1.3) and was substantially higher in unrated hospices (AOR range 1.8-2.0). Within both low- and high-quality hospices, minoritized PWD were more likely to be disenrolled compared with White PWD (AOR range 1.18-1.45). Conclusions: Hospice quality predicts disenrollment, but does not fully explain disparities in disenrollment for minoritized PWD. Efforts to improve racial equity in hospice should focus both on increasing equity in access to high-quality hospices and improving care for racial minoritized PWD in all hospices.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cuidados Paliativos al Final de la Vida / Demencia / Hospitales para Enfermos Terminales Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude / Equity_inequality Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: J Palliat Med Asunto de la revista: SERVICOS DE SAUDE Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cuidados Paliativos al Final de la Vida / Demencia / Hospitales para Enfermos Terminales Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Determinantes_sociais_saude / Equity_inequality Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: J Palliat Med Asunto de la revista: SERVICOS DE SAUDE Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos