Characteristics Associated With Mexican-American Hospice Use: Retrospective Cohort Study Using the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE)

Abstract

Background Hospice use is lower among ethnic/racial minorities in the United States, though little is known about trends, associated factors and duration of hospice use by Mexican-Americans. Aim The purpose of this study is to examine Mexican-American characteristics associated with hospice stay, both ≤ and > 7 days. Design This retrospective cohort study used data from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) and the Centers for Medicare and Medicaid Services. Multivariate logistic regression models were used to estimate the ORs and 95% CIs for hospice stay among Mexican-Americans, both ≤ and > 7 days. Setting and participants The first cohort (N = 970) includes H-EPESE participants who died between 2004 and 2016 who had Medicare parts A and B. The second cohort (N = 403) includes participants who completed the H-EPESE survey within the last 2 years of life. Results Although hospice use increased among Mexican-Americans between 2004 and 2016 (OR 1.88, 95% CI 1.19-2.97), 38% of participants died within the first week of hospice care. Mexican-Americans in New Mexico and Arizona were 2-4 times more likely to use hospice than those in Texas and Colorado. Dementia was associated with hospice use (OR 1.47, 95% CI 1.11-1.94). Characteristics, like church attendance and living alone, were not associated with hospice use. Conclusions The substantial proportion of Mexican-Americans with 7 days or less of hospice use underscores the need for early palliative/hospice intervention to mitigate variation in use.

The Association of Standardized Documentation of Serious Illness Conversations With Healthcare Utilization in Hospitalized Patients: A Propensity Score Matched Cohort Analysis

“…14,15 Documenting code status within 48 hours of admission is associated with less resuscitation attempts and intensive care unit (ICU) admissions. 16 Though hospice enrollment has increased in the last several decades, 17,18 it remains underutilized, including among patients with terminal medical conditions, such as advanced cirrhosis 19 and end-stage heart failure 20 and among patients with hospitalizations prior to death. 21 Clinicians, including hospitalists and primary care professionals at our institution, have previously received training in conducting SICs 22,23 and in documenting these conversations using the institutionally approved electronic health record (EHR) module studied in this manuscript, 24,25 as it facilitates rapid identification of and building upon prior conversations.…”

“… 14 , 15 Documenting code status within 48 hours of admission is associated with less resuscitation attempts and intensive care unit (ICU) admissions. 16 Though hospice enrollment has increased in the last several decades, 17 , 18 it remains underutilized, including among patients with terminal medical conditions, such as advanced cirrhosis 19 and end-stage heart failure 20 and among patients with hospitalizations prior to death. 21 …”