"Lost to follow-up": ethnic disparities in continuity of hospice care at the end of life.
BACKGROUND
Hospice has become the major provider of comprehensive end-of-life care in the United States, but is underutilized by African American patients. It is likely that whatever factors are responsible for lower rates of hospice utilization among African Americans also lead to lower rates of return to hospice after discharge, but this is not known.


OBJECTIVE
To determine whether African American patients who leave hospice are less likely to return before death.


METHODS
Retrospective cohort study.


METHODS
University-affiliated hospice.


METHODS
All patients discharged after a first admission.


METHODS
All patient characteristics were defined by abstraction of electronic medical records at the time of hospice discharge.


RESULTS
Of 358 discharged patients, 98 (27%) were decertified and 260 (73%) left voluntarily. Ninety-six patients returned to hospice during the study period. In bivariate analysis, African Americans were less likely to return than were other patients (odds ratio (OR) 0.47, 95% CI: 0.28-0.80; p = .005). In a multivariable logistic regression model, African American ethnicity was independently associated with a decreased likelihood of return.


CONCLUSIONS
Ethnic disparities in hospice utilization may extend even to those patients who do enroll in hospice. African Americans who leave hospice during their first admission and their families may be less likely to have access to the comprehensive services that hospice programs provide near the end of life, including intensive nursing care, pain and symptom management, and education.
University of Pennsylvania, Department of Medicine Division of Geriatrics and the Institute on Aging, Philadelphia Veterans Affairs Medical Center, USA. Jennifer.Kapo@uphs.upenn.edu
Jennifer
J
Kapo
Holly
H
MacMoran
David
D
Casarett
D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003266:Continuity of Patient Care; D005006:Ethnicity; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D012189:Retrospective Studies; D012935:Social Justice; D013727:Terminal Care