Department of Health Systems Management, Rush University, 1700 W Van Buren St, TOB Ste 126B, Chicago, IL 60612. Email:
Am J Manag Care. 2020 Feb 1;26(2):e36-e40. doi: 10.37765/ajmc.2020.42399.
Prior research has demonstrated differences across race and ethnicity, as well as across geographic location, in palliative care and hospice use for patients near the end of life. However, there remains inconsistent evidence regarding whether these disparities are explained by hospital-level practice variation. The goals of this study were to evaluate whether inpatient palliative care consultation use and discharge to hospice differed by race/ethnicity and whether hospital-level variations explained these differences.
Retrospective, cross-sectional study.
This study evaluated 5613 patients who were discharged to hospice or died during their hospital stay between 2012 and 2014 in 4 urban hospitals with an inpatient palliative care service. The main outcomes were receipt of an inpatient palliative care consultation and discharge to hospice.
The sample was 43% white, 44% African American, and 13% Hispanic. After adjusting for patient characteristics and hospital site, race/ethnicity was not significantly associated with receipt of inpatient palliative care consultation. Hispanic race/ethnicity was associated with a higher likelihood of discharge to hospice (odds ratio, 1.22; P = .036), and inpatient palliative care consultation was associated with 4 times higher likelihood of discharge to hospice (P <.001). Hospital site was also associated with both receipt of inpatient palliative care consultation and discharge to hospice.
Our results illustrate significant variation across hospitals in palliative care consultation use and discharge to hospice. No significant racial/ethnic disparities in the use of either palliative care or hospice at the end of life were found within hospitals.
先前的研究表明，在生命末期，患者接受姑息治疗和临终关怀的情况因种族和民族以及地理位置的不同而存在差异。然而，关于这些差异是否可以通过医院层面的实践差异来解释，仍存在不一致的证据。本研究的目的是评估在住院期间接受姑息治疗咨询和转至临终关怀的情况是否因种族/民族而异，以及医院层面的差异是否可以解释这些差异。
回顾性、横断面研究。
本研究评估了 2012 年至 2014 年间 4 家设有住院姑息治疗服务的城市医院中 5613 名出院至临终关怀或在住院期间死亡的患者。主要结局是接受住院姑息治疗咨询和出院至临终关怀。
样本中 43%为白人，44%为非裔美国人，13%为西班牙裔。在调整了患者特征和医院地点后，种族/民族与接受住院姑息治疗咨询之间没有显著关联。西班牙裔种族/民族与更高的出院至临终关怀的可能性相关（优势比，1.22；P =.036），而住院姑息治疗咨询与出院至临终关怀的可能性增加了 4 倍（P <.001）。医院地点也与住院姑息治疗咨询和出院至临终关怀的使用相关。
我们的结果表明，在医院之间，姑息治疗咨询的使用和出院至临终关怀的情况存在显著差异。在医院内部，没有发现使用姑息治疗或临终关怀方面存在显著的种族/民族差异。
