Health Disparities in Hospice in Nursing Homes

疗养院临终关怀的健康差异

• 批准号: 10733589
• 负责人: Lara K Dhingra
• 金额: $ 71.66万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10733589
• 关键词: Address; Administrator; Adult; Age; Alaska Native; American; American Indians; Asian; Biological; Black race; COVID-19; COVID-19 impact; COVID-19 pandemic; Caring; Categories; Cessation of life; Country; Critical Care; Data; Data Set; Delirium; Disparity; Elderly; Emergency department visit; Enrollment; Equity; Ethnic Origin; Family; Family Caregiver; Government; Health; Hispanic; Hospice Care; Hospitalization; Inequity; Inpatients; Institutional Racism; Interview; Knowledge; Life; Life Expectancy; Location; Long-Term Care; Measures; Medicare; Methods; Modeling; National Institute on Minority Health and Health Disparities; Native Hawaiian or Other Pacific Islander; Not Hispanic or Latino; Nursing Homes; Outcome; Pain; Patients; Policies; Process; Professional Education; Quality Indicator; Quality of Care; Quality of life; Race; Recommendation; Research; Sampling; Services; Specialist; Structural Racism; Structure; Symptoms; Time; Visit; Visiting Nurse; advanced disease; burden of illness; decubitus ulcer; disparity reduction; end of life; end of life care; ethnic difference; ethnic disparity; ethnic minority; evidence base; health disparity; hospice environment; human old age (65+); implicit bias; improved; insight; minority health; minority health disparity; mortality; nursing skill; outcome disparities; pandemic disease; pandemic impact; programs; racial difference; racial disparity; racial minority; sex; Address; Administrator; Adult; Age; Alaska Native; American; American Indians; Asian; Biological; Black race; COVID-19; COVID-19 impact; COVID-19 pandemic; Caring; Categories; Cessation of life; Country; Critical Care; Data; Data Set; Delirium; Disparity; Elderly; Emergency department visit; Enrollment; Equity; Ethnic Origin; Family; Family Caregiver; Government; Health; Hispanic; Hospice Care; Hospitalization; Inequity; Inpatients; Institutional Racism; Interview; Knowledge; Life; Life Expectancy; Location; Long-Term Care; Measures; Medicare; Methods; Modeling; National Institute on Minority Health and Health Disparities; Native Hawaiian or Other Pacific Islander; Not Hispanic or Latino; Nursing Homes; Outcome; Pain; Patients; Policies; Process; Professional Education; Quality Indicator; Quality of Care; Quality of life; Race; Recommendation; Research; Sampling; Services; Specialist; Structural Racism; Structure; Symptoms; Time; Visit; Visiting Nurse; advanced disease; burden of illness; decubitus ulcer; disparity reduction; end of life; end of life care; ethnic difference; ethnic disparity; ethnic minority; evidence base; health disparity; hospice environment; human old age (65+); implicit bias; improved; insight; minority health; minority health disparity; mortality; nursing skill; outcome disparities; pandemic disease; pandemic impact; programs; racial difference; racial disparity; racial minority; sex

In the US, more than 15,600 nursing homes (NHs) provide long-term care to more than 1.3 million elderly adults, of whom about 20% are racial and ethnic minorities. About 40% of NH residents have advanced illness, and prior to the pandemic more than 27% of all deaths in those ages 65 years or older occurred in NHs, making high-quality end-of-life (EOL) care critical. Prior research has found racial and ethnic disparities in NH EOL care. Hospice, a government benefit, allows for EOL care to be provided by a specialist interdisciplinary team. Timely hospice enrollment is a best practice and is recommended for NH residents with advanced illness. However, of those dying in NHs only 1/3 enroll in hospice, and 30% of the enrolled residents receive hospice care for less than a week. Concerns about disparities in NHs related to implicit bias, systemic racism, and structural racism increased with the pandemic. During 2020, racial and ethnic minority NH residents were disproportionately affected by COVID-19 as mortality rose by 32%, yet hospice use decreased in most states. There are gaps in knowledge about racial and ethnic disparities in NH hospice enrollment, the quality of hospice care provided, and related EOL outcomes. How the pandemic impacted hospice use and if any related changes were long lasting is also unknown. To address these gaps, we propose a sequential explanatory mixed methods study guided by Donabedian's Structure, Process, and Outcomes Quality Framework and the NIMHD Minority Health and Health Disparities Framework. Our aims are to: 1) Identify racial and ethnic differences in hospice enrollment and the quality of hospice care provided over time, factors that influence these differences, and how COVID-19 changed these differences; 2) Identify racial and ethnic differences in NH EOL outcomes over time, factors that influence these differences including hospice enrollment and the quality of hospice care, and how COVID-19 changed these differences; and 3) Describe perceived facilitators and barriers that contribute to hospice use and quality of hospice care in racial and ethnic minority NH residents. To achieve Aims 1 and 2, we will use administrative and publicly available data from 2015 to 2024, including the Minimum Data Set and Medicare hospice and inpatient claims (n ≈ 8 million) of NH residents who died and a subset of this sample who enrolled in hospice (n ≈ 2 million). We will include all available racial and ethnic categories and comprehensive measures of hospice enrollment, hospice quality of care, and EOL outcomes. To meet Aim 3, we will purposively sample 16 NHs that vary in location, are either high or low users of hospice, and ≥ 30% of residents are racial or ethnic minorities. We will conduct semi-structured interviews with an administrator, hospice care planner, and 2 family caregivers of racial/ethnic minority decedents (i.e., one that used hospice and one that did not) from each NH. Results from this study will inform evidence-based policies at the national, state, and NH level and influence practice-based initiatives that can promote equitable access to high-quality hospice for diverse Americans living and dying in NHs.

在美国，有15,600多个护士住宅（NHS）为超过130万的长期护理提供长期护理 成年人，其中约20％是种族和少数民族。大约40％的NH居民已提前 疾病，在大流行之前，在65岁以上的所有死亡中，所有死亡人数超过27％。 NHS，使高质量的生命终结（EOL）关怀至关重要。先前的研究发现种族和种族差异 在NH EOL护理中。临终关怀是政府福利，允许专家提供EOL护理 跨学科团队。及时的临终关怀入学是最佳做法，建议NH居民 晚期疾病。但是，在NHS死亡的人中，只有1/3招待会，其中30％的居民 接受临终关怀不到一周。对与隐性偏见，系统性有关的NHS分布的担忧 种族主义和结构性种族主义随着大流行而增加。在2020年，种族和少数民族NH 由于死亡率上升了32％，居民受到COVID-19的影响不成比例，但临终关怀却下降了 在大多数州。关于NH临终关怀入学率的种族和种族差异的知识存在差距 提供的临终关怀护理质量以及相关的EOL成果。大流行如何影响临终关怀的使用以及 任何相关的变化都是持久的，也是未知的。为了解决这些差距，我们提出了一个顺序 Donabedian的结构，过程和结果质量指导的剥夺混合方法研究 框架和NIMHD少数民族健康与健康差异框架。我们的目标是：1）确定 随着时间的流逝，临终关怀入学率和临终关怀护理质量的种族和种族差异，因素 这会影响这些差异，以及COVID-19如何改变这些差异。 2）确定种族和种族 随着时间的推移，NH EOL结果的差异，影响这些差异的因素包括临终关怀 入学率和临终关怀的质量以及Covid-19如何改变了这些差异； 3）描述 感知的促进者和障碍有助于种族和临终关怀护理的临终关怀和质量 NH少数民族居民。为了实现目标1和2，我们将使用管理和公开数据 从2015年到2024年，包括最低数据集和医疗保险临终关怀和住院索赔（n≈800万） 在NH居民中死亡的NH居民和该样本中的一部分，他们参加了临终关怀的居民（n≈200万）。我们将包括 所有可用的种族和种族类别以及临终关怀，临终关怀质量的全面措施 护理和EOL结果。要满足AIM 3，我们通常将采样16个NHS，其位置各不相同，为 临终关怀的高度或低使用者，≥30％的居民是种族或少数民族。我们将进行 与管理员，临终关怀计划师和2名种族/族裔的家庭护理人员的半结构化访谈 少数派决定（即使用临终关怀的人，而没有使用过临终关怀的人）。这项研究的结果 将为国家，州和NH级别的基于证据的政策提供信息，并影响基于实践的计划 这可以为在NHS生活和死亡的潜水美国人提供公平的高质量临终关怀。