Abstract
•Discuss disparities in palliative medicine and hospice utilization.•Evaluate the impact of race/ethnicity and palliative medicine consultation on hospice utilization. Racial disparities in health care access and quality are well documented for some minority groups. However, compared to other areas such as disease prevention, early detection, and curative care, research in disparities in palliative care (PC) is limited. To evaluate whether PC consultation and hospice use differed by race/ethnicity for hospitalized patients at the end of life, and measure the association between PC consultation and use of hospice. The sample included 3,980 patients admitted to three urban hospitals with an inpatient palliative medicine service and were discharged to hospice or died during their hospital stay from 2012-2014. A multilevel binary logistic regression model that accounted for hospital-level clustering of patients was fit to test the association between PC consultation use and race/ethnicity controlling for other patient and hospital characteristics. Another multilevel binary logistic regression model was fit to the association between discharge to hospice with race/ethnicity and PC consultation, controlling for other patient and hospital characteristics. The sample was 45% Caucasian, 39% African American and 17% Hispanic, and 17% (n =682) had a primary diagnosis of cancer. Thirty-four percent received a PC consultation during their hospital stay, and 40% were discharged to hospice. In the multilevel models, race/ethnicity was not associated with receipt of a PC consultation or discharge to hospice. Patients with a PC consultation were 5 times as likely to be discharged to hospice as patients without a consultation (p < 0.001). Contrary to previous studies, no evidence of significant racial/ethnic disparities in the use of either PC or hospice was found. However, there was significant variation across hospitals in the use of both services.
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