Low Hospice Utilization in New York State: Comparisons Using National Data.

Area of Science:

• Health Services Research
• Palliative Care
• Public Health Policy

Background:

• Hospice utilization in New York State (NYS) is notably lower than the national average.
• A prior mixed-methods study identified 54 hospice-related barriers in NYS.

Purpose of the Study:

• To examine national data to understand variables associated with lower hospice utilization in NYS compared to the rest of the U.S.
• To identify factors contributing to disparities in hospice enrollment and length of stay.

Main Methods:

• Utilized ten Medicare and publicly available datasets for traditional Medicare beneficiaries who died in 2018.
• Conducted multivariate analyses to identify variables independently associated with hospice utilization differences between NYS and other states.

Main Results:

• NYS population characteristics: older, more women and minorities, higher socioeconomic status (SES), and more physician visits in the last two years of life.
• NYS healthcare system: more physicians, more skilled nursing facility (SNF) beds, fewer for-profit facilities (hospitals, SNFs, home care, hospice).
• Lower NYS hospice utilization correlated with higher SES, more physician visits, more SNF beds, fewer for-profit SNFs, and fewer hospice agencies.

Conclusions:

• Low hospice utilization in NYS is independently linked to healthcare system factors and patient demographics.
• Findings, combined with stakeholder input, can inform targeted initiatives to enhance hospice care access and utilization in NYS.