July 5, 2017
Black and Hispanic patients are more likely to receive care from poorer-quality hospices, and their family caregivers are less likely to receive the right amount of emotional and religious support in hospice care, according to a new RAND Corporation study.
However, caregivers of black and Hispanic patients report similar or better experiences than caregivers of white patients within a given hospice, according to the study published in the July edition of the journal Health Affairs.
The findings are from the first analysis of trends in the quality of hospice care among different racial and ethnic groups from a new nationwide survey that asks families of hospice patients about issues related to quality of care.
“Our findings highlight the need to ensure that blacks and Hispanics have access to high-quality and culturally competent hospice services,” said Rebecca Anhang Price, the study's lead author and a senior policy researcher at RAND, a nonprofit research organization. “This is particularly important as people from these groups increase their use of hospice services.”
More Americans are enrolling in hospice care at the end of their lives. In 2014, 48 percent of Medicare enrollees who died had received hospice services, compared to 23 percent in 2000. Despite these increases, black and Hispanic patients remain less likely to enroll in hospice care than whites.
Researchers analyzed survey responses from almost 300,000 caregivers whose family members or friends died while receiving hospice care from one of 2,497 hospices in all 50 states and the District of Columbia from April 2015 to March 2016.
The survey is completed by the primary family caregiver of the hospice patient as a part of a federal program to collect information about the quality of patients' experiences. While patients treated in hospitals and other health care settings have been surveyed about quality issues for many years, the survey of experiences in hospices was only required of hospices beginning in 2015.
The RAND study found that black and Hispanic patients are more likely than white patients to receive care from lower-quality hospices, which is consistent with other research that has found that minority patients tend to receive care from lower-quality physician practices and hospitals.
Researchers say that they are uncertain why caregivers of black and Hispanic patients reported better care experiences than caregivers of white patients who received care within the same hospice.
“Our findings highlight the importance of publicizing information about the quality rankings of hospices so that patients and their families can make better-informed decisions about where to receive care,” Anhang Price said. “In addition, more research is needed to understand the differences in experiences among different racial and ethnic groups within the same hospice.”
The study also suggests that officials may want to promote quality improvement efforts at lower-quality hospices through tactics such as increased visits by inspectors. For example, hospices that receive poor reports on the timeliness of care could be reviewed for sufficient staff and the frequency that skilled staff check on patients.
Support for the research was provided by the Centers for Medicaid & Medicare Services. Other authors of the study are Layla Parast, Ann Haas and Marc N. Elliott, all of RAND, and Joan M. Teno of the University of Washington School of Medicine.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.