Dhingra Lara, Braveman Carla, Kassner Cordt, Schechter Clyde, DiFiglia Stephanie, Portenoy Russell
MJHS Institute for Innovation in Palliative Care (L.D., S.D., R.P.), New York, New York, USA; Department of Family and Social Medicine (L.D., C.S., R.P.), Albert Einstein College of Medicine, New York, New York, USA.
Hospice and Palliative Care Association of New York State (HPCANYS) (C.B.), Albany, New York, USA.
J Pain Symptom Manage. 2022 Apr;63(4):522-529. doi: 10.1016/j.jpainsymman.2021.12.013. Epub 2021 Dec 22.
Hospice utilization in New York State (NYS) is low compared to the rest of the U.S.
The first part of a mixed-methods study elicited information from New York State stakeholders and identified 54 hospice-related barriers in nine categories, some specific to NYS. This second part used national data to examine the differences between NYS and the rest of the country by evaluating the variables associated with low NYS hospice utilization.
Ten Medicare or publicly available datasets provided data from the year prior to death for all traditional Medicare-insured patients dying in 2018. Multivariate analyses identified variables independently associated with differences in hospice enrollment or length of stay between NYS and the rest of the country.
The NYS population was relatively older, included more women and minorities, had higher socioeconomic status (SES), and saw more physicians during the last two years of life. NYS had more physicians, more skilled nursing facility (SNF) beds, and fewer for-profit hospitals, SNFs, home care agencies, and hospice agencies. In multivariate analyses, lower NYS hospice utilization was associated with higher SES; more physicians seen during the last two years of life; more SNF beds and fewer for-profit SNF facilities; and fewer hospice agencies.
NYS's low hospice utilization is independently associated with diverse factors, including those related to the health care system. Combined with information from stakeholders, these findings may help target, and inform initiatives to improve hospice utilization.
与美国其他地区相比，纽约州临终关怀服务的利用率较低。
一项混合方法研究的第一部分从纽约州的利益相关者那里获取信息，并确定了九个类别中的54个与临终关怀相关的障碍，其中一些是纽约州特有的。第二部分使用全国数据，通过评估与纽约州临终关怀服务低利用率相关的变量，来研究纽约州与美国其他地区之间的差异。
十个医疗保险或公开可用的数据集提供了2018年所有传统医疗保险参保患者死亡前一年的数据。多变量分析确定了与纽约州和美国其他地区临终关怀服务登记或住院时间差异独立相关的变量。
纽约州的人口相对老龄化，女性和少数族裔更多，社会经济地位（SES）更高，并且在生命的最后两年看医生的次数更多。纽约州有更多的医生、更多的专业护理机构（SNF）床位，以及更少的营利性医院、SNF机构、家庭护理机构和临终关怀机构。在多变量分析中，纽约州临终关怀服务利用率较低与较高的SES、生命最后两年看医生的次数更多、更多的SNF床位和更少的营利性SNF设施，以及更少的临终关怀机构有关。
纽约州临终关怀服务利用率低与多种因素独立相关，包括那些与医疗保健系统相关的因素。结合利益相关者提供的信息，这些发现可能有助于确定目标，并为改善临终关怀服务利用率的举措提供信息。
