Department of Physiological Nursing, University of California, San Francisco, San Francisco, California, USA.
Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA.
J Palliat Med. 2023 Aug;26(8):1100-1108. doi: 10.1089/jpm.2023.0011. Epub 2023 Apr 3.
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. To assess the association between race and disenrollment between and within hospice quality categories in PWD. 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). 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). 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.
患有痴呆症的少数族裔和少数民族患者 (PWD) 被排除在临终关怀之外的风险很高，但对于临终关怀质量与 PWD 被排除在外的种族差异之间的关系知之甚少。评估种族与临终关怀质量类别之间和内部的 PWD 退出之间的关系。这是一项回顾性队列研究，纳入了 2012 年 7 月至 2017 年 12 月期间，100%的 Medicare 受益人的 65 岁及以上患有痴呆症的主要诊断，接受临终关怀的患者。种族和民族（白人/黑人/西班牙裔/亚裔和太平洋岛民[APIA]）使用 Research Triangle Institute（RTI）算法进行评估。临终关怀质量使用公开的医疗保健提供者和系统消费者评估（CAHPS）调查项目对整体临终关怀评级进行评估，包括一个免除公共报告的临终关怀类别（未评级）。该样本包括全国范围内 4371 家临终关怀机构的 673102 名 PWD（平均年龄 86 岁，66%为女性，85%为白人，7.3%为黑人，6.3%为西班牙裔，1.6%为 APIA）。与质量评分最高四分位的临终关怀机构相比，质量评分最低四分位的临终关怀机构（与最高四分位相比）中，白人（调整后的优势比 [AOR] 1.12 [95%置信区间 1.06-1.19]）和少数族裔 PWD（AOR 范围 1.2-1.3）的退出率更高，而未评级的临终关怀机构（AOR 范围 1.8-2.0）则高得多。在低质量和高质量的临终关怀机构中，与白人 PWD 相比，少数族裔 PWD 更有可能被排除在外（AOR 范围 1.18-1.45）。临终关怀质量可预测退出，但并不能完全解释少数族裔 PWD 退出的差异。为改善临终关怀中的种族公平，应既注重增加少数族裔获得高质量临终关怀的机会，又注重改善所有临终关怀机构中少数族裔 PWD 的护理。
