title: Racial Differences in Processes of Care at End of Life in VA Medical Centers: Planned Secondary Analysis of Data from the BEACON Trial.
abstract: BACKGROUND
  Racial differences exist for a number of health conditions, services, and outcomes, including end-of-life (EOL) care.
  
  
  OBJECTIVE
  The aim of the study was to examine differences in processes of care in the last 7 days of life between African American and white inpatients.
  
  
  METHODS
  Secondary analysis was conducted of data collected in the Best Practices for End-of-Life Care for Our Nation's Veterans (BEACON) trial (conducted 2005-2011). Subjects were 4891 inpatient decedents in six Veterans Administration Medical Centers. Data were abstracted from decedents' medical records. Multi-variable analyses were conducted to examine the relationship between race and each of 18 EOL processes of care controlling for patient characteristics, study site, year of death, and whether the observation was pre- or post-intervention.
  
  
  RESULTS
  The sample consisted of 1690 African American patients (34.6%) and 3201 white patients (65.4%). African Americans were less likely to have: do not resuscitate (DNR) orders (odds ratio [OR]: 0.67; p = 0.004), advance directives (OR: 0.71; p = 0.023), active opioid orders (OR: 0.64, p = 0.0008), opioid medications administered (OR: 0.61, p = 0.004), benzodiazepine orders (OR: 0.68, p < 0.0001), benzodiazepines administered (OR: 0.61, p < 0.0001), antipsychotics administered (OR: 0.73, p = 0.004), and steroids administered (OR: 0.76, p = 0.020). Racial differences were not found for other processes of care, including palliative care consultation, pastoral care, antipsychotic and steroid orders, and location of death.
  
  
  CONCLUSIONS
  Racial differences exist in some but not all aspects of EOL care. Further study is needed to understand the extent to which racial differences reflect different patient needs and preferences and whether interventions are needed to reduce disparities in patient/family education or access to quality EOL care.
authors: 1 Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) , Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia .|2 Department of Medicine, School of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.
authors: Kathryn L
authors: KL
authors: Burgio
authors: 1 Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) , Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia .|2 Department of Medicine, School of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.
authors: Beverly R
authors: BR
authors: Williams
authors: 3 School of Nursing, University of Alabama at Birmingham , Birmingham, Alabama.
authors: J Nicholas
authors: JN
authors: Dionne-Odom
authors: 1 Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) , Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia .|4 Department of Biostatistics, School of Public Health, University of Alabama at Birmingham , Birmingham, Alabama.
authors: David T
authors: DT
authors: Redden
authors: 5 University of Alabama , Tuscaloosa, Alabama.
authors: Hyunjin
authors: H
authors: Noh
authors: 1 Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) , Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia .|2 Department of Medicine, School of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.
authors: Patricia S
authors: PS
authors: Goode
authors: 1 Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) , Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia .|2 Department of Medicine, School of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.
authors: Elizabeth
authors: E
authors: Kvale
authors: 1 Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) , Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia .|2 Department of Medicine, School of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.|3 School of Nursing, University of Alabama at Birmingham , Birmingham, Alabama.
authors: Marie
authors: M
authors: Bakitas
authors: 1 Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) , Department of Veterans Affairs, Birmingham, Alabama, and Atlanta, Georgia .|2 Department of Medicine, School of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.|6 Department of Medicine, University of Colorado , Denver, Colorado.
authors: F Amos
authors: FA
authors: Bailey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D044469:Racial Groups; D013727:Terminal Care; D014481:United States; D014493:United States Department of Veterans Affairs