'Live Discharge' More Common for Black, Hispanic Hospice Patients

By Anne Harding

January 11, 2020

NEW YORK (Reuters Health) - Black and Hispanic hospice patients are more than twice as likely as their white peers to be discharged live after acute hospitalization, new research shows.

Living in a zip code with lower levels of income and education also increased the likelihood of live discharge for hospice patients, Dr. David Russell of Appalachian State University in Boone, North Carolina, and colleagues found.

"The black and Hispanic patients are underrepresented in hospice to begin with relative to white patients, and they are less likely to make it into hospice in the first place," Dr. Russell told Reuters Health by phone. "We're identifying risk factors for them leaving prematurely."

In the U.S., a patient is eligible for hospice if he or she is considered to have less than six months to live, and opts not to receive life-sustaining therapies.

As many as 20% of hospice patients experience live discharge, Dr. Russell and his team note in their report in Medical Care. Being disenrolled from hospice before death "is a disruptive and burdensome transition," they note, and has been linked to increased Medicare spending, increased intensive care unit admissions, and "substantial suffering and insecurity" for a patient's caregivers.

Previous research by the authors and others suggested that black, Hispanic and Asian hospice patients were at higher risk of live discharge due to acute hospitalization. In the new study, Dr. Russell and colleagues analyzed electronic medical records of a large, non-profit hospice agency for more than 17,000 patients living in 55 neighborhoods across New York City. Half were white, 17% were black, 20% were Hispanic, and 12% were Asian or of another race or ethnicity.

Half of the patients had cancer, and 90% were being cared for at home.

Among the 2,079 patients with live discharge due to acute hospitalization, 31.4% were white, 27.4% were black, 28.4% were black, and 12.8% were Asian/other. All of the under-represented racial/ethnic groups were significantly more likely to be discharged live compared with white non-Hispanics.

The live-discharge patients were significantly younger, on average, and higher functioning than those who died in hospice, and were also more likely to be on Medicaid.

Neighborhood factors associated with a significantly increased likelihood of live discharge included having a greater percentage of residents who didn't finish high school and a lower percentage of college graduates, as well as living in a neighborhood with more people living below the poverty level or lower median household incomes.

"A logical next step might be to see if this applies to other areas around the country or even try to do a national study to see if these findings of a geographic patterning of live discharges extends to areas outside of New York City," Dr. Russell said.

He and his colleagues also plan to investigate reasons behind the ethnic and racial disparities in live discharge. "It might be that we need to provide additional training to hospital staff like training in cultural sensitivity," the researcher said.

Providing more support and education to family caregivers might also help reduce acute hospitalizations that can lead to live discharge, he added. "They are often the ones that dial 911 and initiate the hospitalization."

SOURCE: https://bit.ly/2TbtEpg Medical Care, online December 24, 2019.