Accommodating ethnic diversity: a study of California hospice programs.
BACKGROUND
Studies have confirmed ethnic disparities in the use of hospice services and identified barriers that minorities face in accessing care.


OBJECTIVE
We sought to determine whether hospices provide services that might affect minority participation.


METHODS
We surveyed California hospices to determine whether programs use diverse health care providers and volunteers, offer translation, diverse spiritual care, or outreach materials and whether they plan to expand such services. Linking the data to the California Office of Statewide Health Planning and Development annual home care and hospice survey and 2000 US Census, we used multivariate linear regression to evaluate the relationship of program characteristics (profit status, size, chain/freestanding status, urban/rural location, and proportion of nonwhite residents) to services that might affect minority participation.


METHODS
One hundred of 149 programs that we surveyed responded.


RESULTS
Many programs offer translation (81%), diverse providers (63%) and volunteers (64%), and culturally diverse spiritual services (52%). Few (21%) were conducting outreach, but 23/25 programs expanding services reported plans to improve outreach. In multivariate models adjusted for program size, chain status, profit status, urban/rural location, proportion of nonwhite residents, we found that larger hospices and those in ethnically diverse zip codes were more likely to offer such services. Larger hospices are more likely to report expanding such services.


CONCLUSIONS
Many hospices are making efforts to accommodate ethnically diverse patients, but a substantial number are not. Culturally appropriate care and outreach should be addressed in efforts to improve the acceptability and experience of hospice care among minorities.
VA Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA. karl.lorenz@med.va.gov
Karl A
KA
Lorenz
Susan L
SL
Ettner
Kenneth E
KE
Rosenfeld
David
D
Carlisle
Hui
H
Liu
Steven M
SM
Asch
D002140:California; D003466:Cultural Characteristics; D018864:Cultural Diversity; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D017051:Hospice Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006738:Hospices / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008913:Minority Groups / Q000706:statistics & numerical data*; D020380:Needs Assessment / Q000706:statistics & numerical data*; D015279:Organizational Culture; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013997:Time Factors