End-of-life hospitalization for African American and non-Latino white nursing home residents: variation by race and a facility's racial composition.

Department of Community Health, Center for Gerontology and Health Care Research, Brown University Medical School, Providence, Rhode Island 02912, USA.
Journal of Palliative Medicine (Impact Factor: 1.91). 03/2005; 8(1):58-68. DOI: 10.1089/jpm.2005.8.58
Source: PubMed


Hospitalization of nursing home residents at the end of life is common, more so among African Americans. Whether a nursing home's racial mix is associated with hospitalization is unknown.
This study examined the association between race, a nursing home's racial mix, and end-of-life hospitalization.
This was a retrospective cohort study.
Studied were nursing home residents in New York (n = 14,159) and Mississippi (n = 1481) who died in 1995-1996 and had a minimum data set (MDS) assessment within 120 days of death.
The outcome measure was the odds of hospitalization in the last 90 days of life. A variable reflecting a nursing home's proportion of African American residents (in 1995-1996) represented a nursing home's racial mix.
Forty-six percent of African Americans and 32% of whites were hospitalized in the last 90 days of life. After controlling for demographics, diagnoses, function, patient preferences (do-not-resuscitate [DNR]), and facility resources, nursing home residents in facilities having higher proportions of African American residents had greater odds of hospitalization (adjusted odds ratio [AOR] 1.14; 95% confidence interval [CI] 1.10, 1.18 in New York and AOR 1.35; 95% CI 1.24, 1.46 in Mississippi). Age and frailty interacted with race; older African Americans had a 16% greater likelihood (95% CI 1.08, 1.24) of hospitalization, and African Americans with more functional limitations had a 37% (95% CI 1.24, 1.51) greater likelihood of hospitalization than did comparable whites.
It appears higher end-of-life hospitalization rates for African American residents are attributable to the facilities where most reside, and to differential hospitalization of older or more functional limited residents.

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    • "Prior studies of factors associated with EOL quality of care have focused largely on measures of nursing home capacity and capability ( Carter & Porell, 2003 ; Mor, Papandonatos, & Miller, 2005 ; Troyer & McAuley, 2006 ). Although researchers have readily acknowledged the importance of processes of care in infl uencing EOL quality of care and outcomes, only a handful of empirical studies have been focused on EOL care processes in nursing homes ( Forbes, Bern-Klug, & Gessert, 2000 ; Jenq, Guo, Drickamer, Marottoli, & Reid, 2004 ; McAuley, Buchanan, Travis, Wang, & Kim, 2006 ). "
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    • "Although a number of studies have examined racial differences at the end of life, little is known about the experiences of dual-eligible (Medicare and Medicaid) nursing home residents, a group that is not only the least studied but potentially the most vulnerable. Most previous studies on racial differences in hospice use and hospitalization have focused on cancer patients and general Medicare nursing home or adult populations (Han, Remsburg, & Iwashyna, 2006; Lackan et al., 2004; Mor et al., 2005; Virnig, Moscovice, Durham, & Casey, 2004). A few exceptions have examined dual-eligible older adults or nursing home residents (Enguidanos et al., 2005; Miller et al., 2004). "
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