Yasemin Evelyn Turkman1, Courtney P Williams2, Bradford E Jackson3, James Nicholas Dionne-Odom4, Richard Taylor4, Deborah Ejem5, Elizabeth Kvale6, Maria Pisu7, Marie Bakitas4, Gabrielle B Rocque8. 1. School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA. Electronic address: yturkman@uab.edu. 2. Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. 3. University of North Texas Health Science Center, Fort Worth, Texas, USA. 4. School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. 5. School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA. 6. Dell Medical School, The University of Texas at Austin, Austin, Texas, USA. 7. Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. 8. School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Comprehensive Cancer Center, UAB Medicine, Birmingham, Alabama, USA.
Abstract
CONTEXT: Hospice utilization is an end-of-life quality indicator. The Deep South has known disparities in palliative care that may affect hospice utilization. OBJECTIVES: The objective of this study was to evaluate the association among Deep South patient and hospital characteristics and hospice utilization. METHODS: This retrospective cohort study evaluated patient and hospital characteristics associated with hospice among Medicare cancer decedents aged ≥65 years in 12 southeastern cancer centers between 2012 and 2015. We examined patient-level characteristics (age, race, gender, cancer type, and received patient navigation) and hospital-level characteristics (board-certified palliative physician, inpatient palliative care beds, and hospice ownership). Outcomes included hospice (within 90 vs. three days of death). Relative risks (RRs) and 95% CIs evaluated the association between patient- and hospital-level characteristics and hospice outcomes using generalized log-linear models with Poisson distribution and robust variance estimates. RESULTS: Of 12,725 cancer decedents, 4142 (33%) did not utilize hospice. "No hospice" was associated with nonwhite (RR 1.24, 95% CI 1.17-1.32) and nonnavigated patients (RR 1.17, 95% CI 1.10-1.25), and those at a hospital with inpatient palliative care beds (RR 1.15, 95% CI 1.10-1.21). "Late hospice" (20%; n = 1458) was associated with being male (RR 1.31, 95% CI 1.19-1.44) and seen at a hospital without inpatient palliative care beds (RR 0.82, 95% CI 0.75-0.90). CONCLUSIONS: Hospice utilization differed by patient and hospital characteristics. Patients who were nonwhite, and nonnavigated, and hospitals with inpatient palliative care beds, were associated with no hospice. Research should focus on ways to improve hospice utilization in Deep South older cancer patients.
CONTEXT: Hospice utilization is an end-of-life quality indicator. The Deep South has known disparities in palliative care that may affect hospice utilization. OBJECTIVES: The objective of this study was to evaluate the association among Deep South patient and hospital characteristics and hospice utilization. METHODS: This retrospective cohort study evaluated patient and hospital characteristics associated with hospice among Medicare cancer decedents aged ≥65 years in 12 southeastern cancer centers between 2012 and 2015. We examined patient-level characteristics (age, race, gender, cancer type, and received patient navigation) and hospital-level characteristics (board-certified palliative physician, inpatient palliative care beds, and hospice ownership). Outcomes included hospice (within 90 vs. three days of death). Relative risks (RRs) and 95% CIs evaluated the association between patient- and hospital-level characteristics and hospice outcomes using generalized log-linear models with Poisson distribution and robust variance estimates. RESULTS: Of 12,725 cancer decedents, 4142 (33%) did not utilize hospice. "No hospice" was associated with nonwhite (RR 1.24, 95% CI 1.17-1.32) and nonnavigated patients (RR 1.17, 95% CI 1.10-1.25), and those at a hospital with inpatient palliative care beds (RR 1.15, 95% CI 1.10-1.21). "Late hospice" (20%; n = 1458) was associated with being male (RR 1.31, 95% CI 1.19-1.44) and seen at a hospital without inpatient palliative care beds (RR 0.82, 95% CI 0.75-0.90). CONCLUSIONS: Hospice utilization differed by patient and hospital characteristics. Patients who were nonwhite, and nonnavigated, and hospitals with inpatient palliative care beds, were associated with no hospice. Research should focus on ways to improve hospice utilization in Deep South older cancerpatients.
Authors: Cathy D Meade; Kristen J Wells; Mariana Arevalo; Ercilia R Calcano; Marlene Rivera; Yolanda Sarmiento; Harold P Freeman; Richard G Roetzheim Journal: J Cancer Educ Date: 2014-09 Impact factor: 2.037
Authors: Gabrielle B Rocque; Edward E Partridge; Maria Pisu; Michelle Y Martin; Wendy Demark-Wahnefried; Aras Acemgil; Kelly Kenzik; Elizabeth A Kvale; Karen Meneses; Xuelin Li; Yufeng Li; Karina I Halilova; Bradford E Jackson; Carol Chambless; Nedra Lisovicz; Mona Fouad; Richard A Taylor Journal: J Oncol Pract Date: 2016-05-10 Impact factor: 3.840
Authors: Gabrielle B Rocque; Richard A Taylor; Aras Acemgil; Xuelin Li; Maria Pisu; Kelly Kenzik; Bradford E Jackson; Karina I Halilova; Wendy Demark-Wahnefried; Karen Meneses; Yufeng Li; Michelle Y Martin; Carol Chambless; Nedra Lisovicz; Mona Fouad; Edward E Partridge; Elizabeth A Kvale Journal: J Natl Compr Canc Netw Date: 2016-04 Impact factor: 11.908
Authors: Gabrielle B Rocque; J Nicholas Dionne-Odom; Chao-Hui Sylvia Huang; Soumya J Niranjan; Courtney P Williams; Bradford E Jackson; Karina I Halilova; Kelly M Kenzik; Kerri S Bevis; Audrey S Wallace; Nedra Lisovicz; Richard A Taylor; Maria Pisu; Edward E Partridge; Thomas W Butler; Linda A Briggs; Elizabeth A Kvale Journal: J Pain Symptom Manage Date: 2017-01-03 Impact factor: 3.612
Authors: Kathleen M Fairfield; Kimberly M Murray; Heidi R Wierman; Paul K J Han; Sarah Hallen; Susan Miesfeldt; Edward L Trimble; Joan L Warren; Craig C Earle Journal: Gynecol Oncol Date: 2011-12-01 Impact factor: 5.482