Despite the rapid growth of hospice care in the US over the past several decades, racial/ethnic minorities continue to utilize higher levels of aggressive life-prolonging interventions at end of life which often result in poorer care experiences. While previous research has expanded understanding of racial/ethnic end-of-life disparities outside of hospice, an in-depth analysis of the relationship between patient care preferences and key end-of-life outcomes among a racially/ethnically diverse hospice population remains to be conducted. The long-term objective of this research is to examine racial/ethnic differences in advance care planning, acute care utilization, hospice length of stay, and site of death following hospice enrollment. Findings will address significant gaps in the literature, inform policy, and guide innovative models of care for diverse populations at end of life. The proposed research will address the following specific aims: 1) explore the relationship between race/ethnicity and advance care planning among hospice patients;2) identify the effect that advance care planning and patient race/ethnicity have on acute care utilization following hospice enrollment;and 3) investigate the influence that advance care planning and patient race/ethnicity have on hospice length of stay and site of death. The central hypothesis of this study is that race/ethnicity will influence acute care utilization, hospice length of stay, and sit of death among hospice patients, after adjusting for care preferences and key sociodemographic and health characteristics. To address these objectives, a retrospective analysis of clinical and service use outcomes among Medicare hospice patients will be conducted using the 2007 wave of the National Home Health and Hospice Care Survey (NHHCS), a nationally representative survey of 1,036 agencies. Data on 3,714 Medicare hospice patients over the age of 65 were collected and are available for analysis. When weighted for national representation, these data represent 800,872 older adults. Analytic methods will include preliminary univariate and bivariate analyses, binary logistic regression, and Cox Proportional Hazards models. Minorities utilize more life-sustaining interventions at end of life, resulting in substantially higher costs nd poorer care experiences. Although studies have documented improved quality of care with receipt of hospice, minority care experiences following hospice enrollment remain unstudied. The proposed study will further understanding of care preferences and service use outcomes among a racially/ethnically diverse hospice population. This increased understanding can inform policy to improve access to and continuity of hospice care for an increasingly diverse group of older adults.

Public Health Relevance

While research has consistently demonstrated that racial/ethnic minorities receive more life-prolonging interventions and less palliative-based care at end of life, minority care preferences and outcomes following hospice enrollment remain understudied. The proposed study will provide an initial examination of the relationship between care preferences, acute care utilization, hospice length of stay, and site of death among a racially/ethnically diverse Medicare hospice population. Findings will inform policy and guide innovative models of care at end of life.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Dissertation Award (R36)
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National Institute on Aging Initial Review Group (NIA)
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Bhattacharyya, Partha
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University of Southern California
Other Domestic Higher Education
Los Angeles
United States
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