Amelia Barwise1,2, Young J Juhn3, Chung-Il Wi3, Paul Novotny4, Carolina Jaramillo2,5, Ognjen Gajic1, Michael E Wilson1,2,6. 1. 1 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA. 2. 2 Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA. 3. 3 Asthma Epidemiology Research Unit and Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA. 4. 4 Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA. 5. 5 Harvard Medical School, Boston, MA, USA. 6. 6 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Abstract
BACKGROUND: : Socioeconomic status (SES) is an important determinant of disparities in health care and may play a role in end-of-life care and decision-making. The SES is difficult to retrospectively abstract from current electronic medical records and data sets. OBJECTIVE: : Using a validated SES measuring tool derived from home address, the HOUsing-based SocioEconomic Status index, termed HOUSES we wanted to determine whether SES is associated with differences in end-of-life care and decision-making. DESIGN/SETTING/PARTICIPANTS:: This cross-sectional study utilized a cohort of Olmsted County adult residents admitted to 7 intensive care units (ICUs) at Mayo Rochester between June 1, 2011, and May 31, 2014. MEASUREMENTS:: Multiple variables that reflect decision-making and care at end of life and during critical illness were evaluated, including presence of advance directives and discharge disposition. The SES was measured by individual housing-based SES index (HOUSES index; a composite index derived from real property as a standardized z-score) at the date of admission to the ICU which was then divided into 4 quartiles. The greater HOUSES, the higher SES, outcomes were adjusted for age, 24-hour Acute Physiology and Chronic Health Evaluation III score, sex, race/ethnicity, and insurance. RESULTS: : Among the eligible 4134 participants, the addresses of 3393 (82%) were successfully geocoded and formulated into HOUSES. The adjusted odds ratios comparing HOUSES 1 versus 2, 3, and 4 demonstrated lower likelihood of advance directives -0.77(95% CI: 0.63-0.93) and lower likelihood of discharge to home -0.60(95% CI: 1.0.5-0.72). CONCLUSION: : Lower SES, derived from a composite index of housing attributes, was associated with lower rates of advance directives and lower likelihood of discharge to home.
BACKGROUND: : Socioeconomic status (SES) is an important determinant of disparities in health care and may play a role in end-of-life care and decision-making. The SES is difficult to retrospectively abstract from current electronic medical records and data sets. OBJECTIVE: : Using a validated SES measuring tool derived from home address, the HOUsing-based SocioEconomic Status index, termed HOUSES we wanted to determine whether SES is associated with differences in end-of-life care and decision-making. DESIGN/SETTING/PARTICIPANTS:: This cross-sectional study utilized a cohort of Olmsted County adult residents admitted to 7 intensive care units (ICUs) at Mayo Rochester between June 1, 2011, and May 31, 2014. MEASUREMENTS:: Multiple variables that reflect decision-making and care at end of life and during critical illness were evaluated, including presence of advance directives and discharge disposition. The SES was measured by individual housing-based SES index (HOUSES index; a composite index derived from real property as a standardized z-score) at the date of admission to the ICU which was then divided into 4 quartiles. The greater HOUSES, the higher SES, outcomes were adjusted for age, 24-hour Acute Physiology and Chronic Health Evaluation III score, sex, race/ethnicity, and insurance. RESULTS: : Among the eligible 4134 participants, the addresses of 3393 (82%) were successfully geocoded and formulated into HOUSES. The adjusted odds ratios comparing HOUSES 1 versus 2, 3, and 4 demonstrated lower likelihood of advance directives -0.77(95% CI: 0.63-0.93) and lower likelihood of discharge to home -0.60(95% CI: 1.0.5-0.72). CONCLUSION: : Lower SES, derived from a composite index of housing attributes, was associated with lower rates of advance directives and lower likelihood of discharge to home.
Entities:
Keywords:
HOUSES index; advance directives; decision-making; discharge disposition; end-of-life care; social work referral; socioeconomic status
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