Barriers to Hospice Care in Trauma Patients: The Disparities in End-of-Life Care
| Autor: | Tiffany Zens, Krista Haines, Hee Soo Jung, Charles Warner-Hillard, Scott A. Turner, Suresh Agarwal |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Palliative care Cirrhosis Comorbidity Disease Logistic regression Health Services Accessibility Insurance Coverage 03 medical and health sciences Sex Factors 0302 clinical medicine medicine Humans 030212 general & internal medicine Healthcare Disparities Socioeconomic status Aged Retrospective Studies Aged 80 and over Terminal Care Insurance Health Trauma Severity Indices business.industry Racial Groups Age Factors Retrospective cohort study General Medicine Middle Aged medicine.disease Hospice Care Socioeconomic Factors 030220 oncology & carcinogenesis Emergency medicine Wounds and Injuries Female business End-of-life care |
| Zdroj: | American Journal of Hospice and Palliative Medicine®. 35:1081-1084 |
| ISSN: | 1938-2715 1049-9091 |
| DOI: | 10.1177/1049909117753377 |
| Popis: | Introduction: End-of-life and palliative care are important aspects of trauma care and are not well defined. This analysis evaluates the racial and socioeconomic disparities in terms of utilization of hospice services for critically ill trauma patients. Methods: Trauma patients ≥15 years old from 2012 to 2015 were queried from the National Trauma Databank. Chi-square and multivariate logistic regression analyses for disposition to hospice were performed after controlling for age, gender, comorbidities, injury severity, insurance, race, and ethnicity. Negative binomial regression analysis with margins for length of stay (LOS) was calculated for all patients discharged to hospice. Results: Chi-square analysis of 2 966 444 patient’s transition to hospice found patients with cardiac disease, bleeding and psychiatric disorders, chemotherapy, cancer, diabetes, cirrhosis, respiratory disease, renal failure, cirrhosis, and cerebrovascular accident (CVA) affected transfer ( P < .0001). Logistic regression analysis after controlling for covariates showed uninsured patients were discharged to hospice significantly less than insured patients (odds ratio [OR]: 0.71; P < .0001). Asian, African American, and Hispanic patients all received less hospice care than Caucasian patients (OR: 0.65, 0.60, 0.73; P < .0001). Negative binomial regression analysis with margins for LOS showed Medicare patients were transferred to hospice 1.2 days sooner than insured patients while uninsured patients remained in the hospital 1.6 days longer ( P < .001). When compare to Caucasians, African Americans patients stayed 3.7 days longer in the hospital and Hispanics 2.4 days longer prior to transfer to hospice ( P < .0001). In all patients with polytrauma, African Americans stayed 4.9 days longer and Hispanics 2.3 days longer as compared to Caucasians ( P < .0001). Conclusions: Race and ethnicity are independent predictors of a trauma patient’s transition to hospice care and significantly affect LOS. Our data demonstrate prominent racial and socioeconomic disparities exist, with uninsured and minority patients being less likely to receive hospice services and having a delay in transition to hospice care when compared to their insured Caucasian counterparts. |
| Databáze: | OpenAIRE |
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