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Factors Associated With Home-Hospice Utilization.

Zainab Toteh Osakwe, Bhavleen K Arora, Mandi-Leigh Peterson

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|January 8, 2021

Summary

Racial and ethnic minorities use hospice less. Factors like dementia diagnoses, dual enrollment, and Hispanic community density influence home-hospice utilization, requiring further investigation.

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Area of Science:

Gerontology
Public Health
Health Disparities

Background:

Hospice care utilization is lower among racial and ethnic minority groups compared to White populations, even after accounting for socioeconomic factors.
Patient, provider, and community characteristics may impact the use of home-hospice services.

Purpose of the Study:

To identify patient, provider, and community factors associated with home-hospice utilization.
To understand disparities in end-of-life care access.

Main Methods:

Analysis of 1,208,700 hospice patients receiving home-hospice care.
Data sourced from 2,148 Medicare-certified hospice providers in 2016.
Statistical analysis using logistic regression to determine odds ratios (OR) and confidence intervals (CI).

Main Results:

Increased proportion of dementia diagnoses correlated with decreased odds of home-hospice provision (OR = 1.42, 95% CI = 1.36-1.48).
Providers with higher dual-enrollment patient proportions showed reduced likelihood of providing home-hospice (OR = 1.42, 95% CI = 1.36-1.48).
Hospices in ZIP codes with higher Hispanic resident proportions were less likely to offer home-hospice (OR = 1.00, 95% CI = 0.99-0.99).

Conclusions:

Specific patient diagnoses (dementia), provider characteristics (dual enrollment), and community demographics (Hispanic population density) are associated with reduced home-hospice use.
These findings highlight potential barriers to equitable home-hospice access for minority populations.
Further research is necessary to elucidate the underlying mechanisms driving these observed associations.