Racial Disparities in High- and Low-Value Healthcare Services Received in the Final Year of Life for Medicare Beneficiaries with Neurodegenerative Diseases (P4-9.001)

Abstract

<h3>Objective:</h3> To determine if receipt of high- and low-value healthcare services in the final year of life differ by race for patients with neurodegenerative diseases (NDD), defined as any form of dementia or Parkinson’s disease. <h3>Background:</h3> Prior studies have shown substantial racial disparities in care received by patients with NDD. However, no studies have evaluated disparities in the value (defined as the ratio of benefit to cost) of care received in the last year of life, a time period that is important to patients and families and is associated with high healthcare expenditures. <h3>Design/Methods:</h3> This was a retrospective cohort study of Medicare beneficiaries in North and South Carolina from 2013–2017. Low-value healthcare services were selected from the Choosing Wisely initiative and included contraindicated cancer screening, peripheral artery stenting, and feeding tube placement. High-value healthcare services included receipt of physical or occupational therapy, hospice care, or cost-effective medications indicated to treat NDD. <h3>Results:</h3> Among 70,650 decedents, 13,753 were Black, 55,765 were White, 93.1% had dementia, and 7.7% had Parkinson’s disease. Adjusting for age, sex, Medicaid dual enrollment status, rural vs urban location, state (NC, SC), and comorbidities, Black decedents were more likely to receive low-value care including colorectal cancer screening (adjusted hazard ratio (aHR) 1.46 [1.32–1.61]), peripheral artery stenting (aHR 1.72 [1.43, 2.08]), and feeding tube placement (aHR 2.96 [2.70–3.24]) and less likely to receive physical therapy (aHR 0.73 [0.64, 0.85)], dementia medications (aHR 0.90 [0.86, 0.95]), or Parkinson’s disease medications (aHR 0.88 [0.75, 1.02]) within the last year of life, and were less likely to be admitted to hospice (aHR 0.82 [0.79–0.85]). <h3>Conclusions:</h3> Complex, systemic dynamics beyond healthcare access alone may drive racial disparities in end-of-life care for patients with NDD. Interventions to improve health equity in end-of-life settings are desperately needed. <b>Disclosure:</b> Mr. Lusk has received research support from American Heart Association. Dr. Ford has nothing to disclose. Ms. Greiner has nothing to disclose. An immediate family member of Dr. Clark has received personal compensation for serving as an employee of Blue Cross Blue Shield of NC. Dr. Johnson has nothing to disclose. The institution of Brystana Kaufman has received research support from AstraZeneca. The institution of Brystana Kaufman has received research support from NIH. The institution of Brystana Kaufman has received research support from 199. Dr. Mantri has received personal compensation in the range of $0-$499 for serving as a Consultant for Deep Brain Innovations, LLC. Dr. Mantri has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Grey Matter Technology. The institution of Dr. Mantri has received research support from The Michael J Fox Foundation for Parkinson Research. Dr. Xian has nothing to disclose. Dr. O’Brien has nothing to disclose. Dr. O’Brien has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boehringer Ingelheim. The institution of Dr. O’Brien has received research support from Pfizer. The institution of Dr. O’Brien has received research support from BMS. Dr. Goetz has nothing to disclose.