title: Lack of ethnic differences in end-of-life care in the Veterans Health Administration.
abstract: Although existing literature shows pervasive ethnic disparities in end-of-life care, this study sought to determine if there were ethnic differences in the processes of care related to the end of life in a cohort of hospitalized, seriously ill veterans. The medical records of 217 patients (13% African American, 68% white, 9% Hispanic White) were reviewed for documentation of end-of-life care (advance directive discussions, pain, symptom-directed plan, and do-not-resuscitate orders). Logistic regression modeling demonstrated no ethnic differences for the treatment of pain or a symptom-directed plan of care. African American patients were more likely to have a do-not-resuscitate order and advance directive discussion documented compared with white patients. In this equal access system, minority patients were at least as likely or more likely to have important aspects of end-of-life care addressed compared with white patients.
authors.affiliation: Division of Health Care Policy and Research, University of Colorado Health Sciences Center, 13611 E. Colfax Avenue, Aurora, CO 80011, USA. Stacy.Fischer@uchsc.edu
authors.forename: Stacy M
authors.initials: SM
authors.lastname: Fischer
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
authors.forename: Angela
authors.initials: A
authors.lastname: Sauaia
authors.forename: Andrew
authors.initials: A
authors.lastname: Kramer
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003120:Colorado; D018864:Cultural Diversity; D004282:Documentation; D005260:Female; D006302:Health Services Research; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control; D010347:Patient Care Planning; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D044465:White People / Q000706:statistics & numerical data