DeForge Christine E, Ma Hsin S, Dick Andrew W, Stone Patricia W, Orewa Gregory N, Dhingra Lara, Portenoy Russell, Quigley Denise D
Columbia University School of Nursing, Center for Health Policy, New York, NY, USA.
Pardee RAND Graduate School, Santa Monica, CA, USA.
Am J Hosp Palliat Care. 2025 Jan 9:10499091251313761. doi: 10.1177/10499091251313761.
Hospice can improve end-of-life (EOL) outcomes in U.S. nursing homes (NHs). However, only one-third of eligible residents enroll, and substantial variation exists within and across NHs related to resident-, NH-, or community-level factors. We conducted a review of English-language, peer-reviewed articles 2008 to 2023 describing this variation in NH hospice use to characterize disparities and inform educational and quality initiatives to improve EOL care in NHs. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We screened 1595 records, reviewed 82 articles and included 13 articles. Eleven used pre-2009 data. Six evaluated national data and 7 used regional (n = 1), state (n = 4), or local (n = 2) data. One assessed hospice referral, 10 hospice use, and 3 length-of-stay. Twelve conducted regression analyses; 1 stratified by race, another evaluated interaction terms, and a third compared racial differences within-and between-facilities. Unadjusted and adjusted differences were evaluated by resident race-and-ethnicity (n = 6 unadjusted, n = 10 adjusted, respectively), sex (n = 5, n = 9), or payor (n = 1, n = 4), or by NH race-mix (n = 1, n = 2), ownership (n = 1, n = 7), payor-mix (n = 1, n = 5), or urban/rural location (n = 1 adjusted). Unadjusted differences showed lower hospice use by Non-White residents and varied results by sex. Studies adjusting for resident-, NH-, and community-level factors found lower hospice use among male residents, Black/Non-White residents, and residents of rural NHs, with mixed results by payor and ownership. Results were mixed for hospice referral and length-of-stay. These findings suggest complex influences on NH hospice use. Further study is warranted to identify targets for improving hospice access.
临终关怀可改善美国养老院的临终（EOL）结局。然而，只有三分之一符合条件的居民登记入住，并且在养老院内部以及不同养老院之间，与居民、养老院或社区层面的因素相关存在着显著差异。我们对2008年至2023年期间描述养老院临终关怀使用情况差异的英文同行评审文章进行了综述，以描述差异情况，并为改善养老院临终关怀的教育和质量举措提供信息。我们遵循系统评价和Meta分析的首选报告项目指南。我们筛选了1595条记录，审查了82篇文章，并纳入了13篇文章。其中11篇使用了2009年之前的数据。6篇评估了全国数据，7篇使用了区域（1篇）、州（4篇）或地方（2篇）数据。1篇评估了临终关怀转诊情况，10篇评估了临终关怀使用情况，3篇评估了住院时间。12篇进行了回归分析；1篇按种族分层，另一篇评估了交互项，第三篇比较了机构内部和机构之间的种族差异。未调整和调整后的差异按居民种族和族裔（分别为6篇未调整、10篇调整）、性别（5篇、9篇）或付款人（1篇、4篇），或按养老院种族构成（1篇、2篇）、所有权（1篇、7篇）、付款人构成（1篇、5篇）或城乡位置（1篇调整）进行评估。未调整的差异显示非白人居民的临终关怀使用率较低，且按性别结果各异。对居民、养老院和社区层面因素进行调整的研究发现，男性居民、黑人/非白人居民以及农村养老院居民的临终关怀使用率较低，付款人和所有权方面的结果不一。临终关怀转诊和住院时间的结果不一。这些发现表明对养老院临终关怀使用存在复杂影响。有必要进一步研究以确定改善临终关怀可及性的目标。
