Quality of Hospice Care

Baernholdt, Marianne; Campbell, Christopher J.; Hinton, Ivora; Gao, Yan; Lewis, Erica

doi:10.1097/ncq.0000000000000108

Cited by 17 publications

(7 citation statements)

References 25 publications

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“…This finding is consistent with the only other published study we could identify in the literature, one that was limited to a small number of patients at one regional hospice organization. 51 Collectively, these findings suggest that, although the rurality of a veteran may be associated with a lower likelihood of receiving certain components of high-quality EOL care, families' experiences of care are similar across the rural-urban continuum.…”

Section: Discussionmentioning

confidence: 91%

Does Quality of End‐of‐Life Care Differ by Urban‐Rural Location? A Comparison of Processes and Family Evaluations of Care in the VA

Rosario

Kutney‐Lee

Sochalski

et al. 2019

The Journal of Rural Health

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Purpose Several studies have identified differences in end‐of‐life (EOL) care between urban and rural areas, yet little is known about potential differences in care processes or family evaluations of care. The purpose of this study was to examine the relationship between rurality of residence and quality of EOL care within the Veterans Affairs health care system. Methods This study was a retrospective, cross‐sectional analysis of 126,475 veterans who died from October 2009 through September 2016 in inpatient settings across 151 facilities. Using unadjusted and adjusted logistic regression, we compared quality of EOL care between urban and rural veterans using family evaluations of care and 4 quality of care indicators for receipt of (1) palliative care consult, (2) a chaplain visit, (3) death in an inpatient hospice unit, and (4) bereavement support. Findings Veterans from rural areas had lower odds of dying in an inpatient hospice unit compared to veterans from urban areas, before and after adjustment (large rural OR 0.73, 95% CI: 0.70‐0.77; P < .001, small rural OR 0.81, 95% CI: 0.77‐0.86; P < .001, isolated rural OR 0.87, 95% CI: 0.81‐0.93; P < .001). Differences in comparisons of other quality of care indicators were small and of mixed significance. No significant differences were found in family ratings of care in fully adjusted models. Conclusion Receipt of some EOL quality indicators differed with urban‐rural residence for some comparisons. However, family ratings of care did not. Our findings call for further investigation into unmeasured individual characteristics and facility processes related to rurality.

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Section: Discussionmentioning

confidence: 91%

Does Quality of End‐of‐Life Care Differ by Urban‐Rural Location? A Comparison of Processes and Family Evaluations of Care in the VA

Rosario

Kutney‐Lee

Sochalski

et al. 2019

The Journal of Rural Health

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“…In another study using the Surveillance Epidemiology and End Results‐Consumer Assessment of Healthcare Providers and Systems, researchers identified rural–urban differences in satisfaction with the timeliness and ease of care among Medicare beneficiaries with a cancer diagnosis with rural patients indicating lower satisfaction with timeliness 31 . In a study of hospice patients and their families, rural participants indicated better satisfaction with pain management as compared with urban participants 32 . Taken together, these studies show conflicting findings based upon number of geographic groupings, operationalization of realized acceptability, age of cohort, and treatment received.…”

Section: Discussionmentioning

confidence: 99%

“…31 In a study of hospice patients and their families, rural participants indicated better satisfaction with pain management as compared with urban participants. 32 This is especially critical as many other assessments of quality are performed at the provider or hospital level as an aggregate of their patients' perceptions or other metrics, but rural or urban location of the provider or hospital is not always concordant with the rural or urban residency of the patient. 33 Our findings showed that, even after adjustment for covariates, for some county-based measures of rurality, rural participants had greater probability of self-reported provider attentiveness (a measure of realized accommodation).…”

Section: Discussionmentioning

confidence: 99%

Definition and categorization of rural and assessment of realized access to care

Zahnd

Vecchio

Askelson

et al. 2022

Health Services Research

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Objective To examine how three measures of realized access to care vary by definitions and categorizations of “rural”. Data sources Health Information National Trends Survey (HINTS) data, a nationally representative survey assessing knowledge of health‐related information, were used. Participants were categorized by county‐based Urban Influence Codes (UICs), Rural–Urban Continuum Codes (RUCCs), and census tract‐based Rural–Urban Commuting Area (RUCAs). Study design Three approaches were used across categories of UICs, RUCCs, and RUCAs: (1) non‐metropolitan/metropolitan, (2) three‐group categorization based upon population size, and (3) three‐group categorization based on adjacency to metropolitan areas. Wald Chi‐square tests evaluated differences in sociodemographic variables and three measures of realized access across three of Penchansky's “A's of access” and approaches. The three outcome measures included: having a regular provider (realized availability), self‐reported “excellent” quality of care (realized acceptability), and self‐report of the provider “always” spending enough time with you (provider attentiveness–realized accommodation). The average marginal effects corresponding to each outcome were calculated. Data collection/extraction methods N/A Principal findings All approaches indicated comparable variation in sociodemographics. In all approaches, RUCA‐based categorizations showed differences in having a regular provider (e.g., 68.9% of non‐metropolitan and 64.4% of metropolitan participants had a regular provider). This association was attenuated in multivariable analyses. No rural–urban differences in quality of care were seen in unadjusted or adjusted analyses regardless of approach. After adjustment for covariates, rural respondents reported greater provider attentiveness in some categorizations of rural compared with urban (e.g., non‐metropolitan respondents reported 6.03 percentage point increase in probability of having an attentive provider [CI = 0.76–11.31%] compared with metropolitan). Conclusions Our findings underscore the importance of considering multiple definitions of rural to understand access disparities and suggest that continued research is needed to examine the interplay between potential and realized access. These findings have implications for federal funding, resource allocation, and identifying health disparities.

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“…49 However, a prior study found that rural hospice patients and families are more likely to report overall satisfaction with care than their urban counterparts, and authors of the study attributed their finding in part to rural residents being more conscious of community members’ needs and willing to help if necessary. 50 Therefore, one may argue that if rural community members learn about hospice care and its volunteer opportunities and receive needed trainings, they can support socially isolated terminally ill patients and families in their community. Yet, strategies to recruit and retain hospice workforce and volunteers in rural areas should continue to be explored.…”

Section: Discussionmentioning

confidence: 99%

Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework

Noh

Lee

et al. 2021

Am J Hosp Palliat Care

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Background: Despite the need for hospice care as our society ages, adults in the U.S.’s southern rural region have limited awareness of hospice care. Objective: This study aims to assess the rate of awareness of hospice care among rural residents living in Alabama’s Black Belt region and examine social determinants of health (SDH) associated with the awareness. Methods: A cross-sectional survey was conducted among a convenience sample living in Alabama’s Black Belt region (N = 179, age = 18-91). Participants’ awareness of hospice care, demographic characteristics (ie, age and gender), and SDH (ie, financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and hospice awareness among participants while controlling for demographic characteristics. Results: The majority of participants had heard of hospice care (n = 150, 82.1%), and older participants (50 years old or older) were more likely to report having heard of hospice care ( OR = 7.35, P < 0.05). Participants reporting worries about stable housing (OR = 0.05, P < 0.05) and higher social isolation were less likely to have heard of hospice care ( OR = 0.53, P < 0.05), while participants with higher health literacy had a higher likelihood to have heard of it ( OR = 2.60, P < 0.01). Conclusions: Our study is the first study assessing the status of hospice awareness among residents of Alabama’s Black Belt region. This study highlighted that factors including age and certain SDH (ie, housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice awareness.

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Quality of Hospice Care

Cited by 17 publications

References 25 publications

Does Quality of End‐of‐Life Care Differ by Urban‐Rural Location? A Comparison of Processes and Family Evaluations of Care in the VA

Does Quality of End‐of‐Life Care Differ by Urban‐Rural Location? A Comparison of Processes and Family Evaluations of Care in the VA

Definition and categorization of rural and assessment of realized access to care

Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework

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