Black And Hispanic Patients Receive Hospice Care Similar To That Of White Patients When In The Same Hospices

Published in: Health Affairs, Volume 36, Number 7 (July 2017), pages 1283-1290. doi: 10.1377/hlthaff.2017.0151

Posted on RAND.org on August 01, 2017

by Rebecca Anhang Price, Layla Parast, Ann C. Haas, Joan M. Teno, Marc N. Elliott

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Research Questions

  1. Do caregivers' reports of quality of care on the CAHPS® Hospice Survey differ by race and/or ethnicity?
  2. Are variations in caregivers' ratings due to the concentration of racial/ethnic groups in certain hospices, or due to differences in care they receive within the same hospice?

Little is known about racial and ethnic variation in the quality of hospice care. We used data on 292,516 respondents for 2015–16 from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey to assess how the patient and family experience of hospice care differed among black, Hispanic, and white patients. We found that, on average, black and Hispanic patients received care from poorer quality hospices. Within a given hospice, we found that friends and relatives who served as caregivers of black and Hispanic patients reported significantly better hospice care experiences than their peers serving as caregivers of white patients on five of seven outcomes. However, caregivers of black and Hispanic patients reported receiving their desired level of emotional and religious support less often than caregivers of white patients did. As more black and Hispanic patients enroll in hospice care, it is critical to ensure that they have access to high-quality, culturally competent hospice services.

Key Findings

  • Black and Hispanic patients tended to receive care at facilities with relatively poor quality ratings.
  • Within a given facility, caregivers of black and Hispanic patients rated care as similar or better than caregivers of white patients.
  • Caregivers of black and Hispanic patients reported worse care experiences on the dimension of emotional and religious support.
  • Care experiences are worse in hospices with higher proportions of black or Hispanic patients.
  • Hispanic patients have better care experiences than white patients in hospices with high proportions of Hispanic patients, perhaps because these hospices specialize in caring for Hispanic patients and families.

Recommendations

Policy priorities should include:

  • Improving the overall care experiences in hospices that serve higher proportions of black and Hispanic patients
  • Improving awareness of and access to high-quality hospice care among black and Hispanic patients
  • Improving provision of emotional and religious support for black and Hispanic patients

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