TY - JOUR
T1 - Differences of Quality in End-of-Life Care across Settings
T2 - Results from the U.S. National Health and Aging Trends Study of Medicare Beneficiaries
AU - Xu, Shuo
AU - Liu, Mangdong
AU - Shin, Oejin
AU - Parker, Vanessa
AU - Hernandez, Rosalba
N1 - Funding Information:
The NHATS is a U.S.-based prospective cohort study that collects survey data from a nationally representative sample of Medicare beneficiaries at age 65 years or older. The NHATS is sponsored by the National Institute on Aging (Grant No. NIA U01AG032947) and led by the Johns Hopkins University Bloomberg School of Public Health.24 NHATS enrolled 8245 participants at baseline in 2011. Participants or proxy respondents have been subsequently re-interviewed annually. Details of the design and protocol for NHATS can be found in Kasper and Freedman.24
Funding Information:
This project was not funded by any supporting resources.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Background: More than 2.5 million older Americans die each year. Place of residence in which dying patients receive care plays a crucial role in the quality of end-of-life (EOL) care. Objective: This study aimed to compare proxies' overall rating and ratings for 13 indicators across five major domains of EOL care by place of residence in the last month of decedents' lives. Design: We used data from the National Health and Aging Trends Study, a nationally representative study of Medicare beneficiaries at age 65 years and older in the United States. Setting/Subjects: Analyses included proxies (N = 1336) of Medicare beneficiaries who passed away between 2013 and 2016. Proxies were categorized into four groups, depending on place of residence in the last month of life and the involvement of hospice. Measurements: Quality of EOL care was assessed using questions modeled after quality of EOL care instruments. We adjusted for demographic data of decedents and proxies. Results: Hospice recipients, regardless of setting, were more likely to experience pain and talk about religion in the last month of life; families of patients without hospice in residential care settings were more likely to report not being kept informed; proxies of patients living in private residences with hospice care reported higher overall ratings. Among hospice recipients, those living in private residences were more likely to be treated with respect. Conclusions: Disparities exist across settings and in overall ratings for quality of EOL domains - particularly, the subdomains of symptom management, decision making, and spiritual needs.
AB - Background: More than 2.5 million older Americans die each year. Place of residence in which dying patients receive care plays a crucial role in the quality of end-of-life (EOL) care. Objective: This study aimed to compare proxies' overall rating and ratings for 13 indicators across five major domains of EOL care by place of residence in the last month of decedents' lives. Design: We used data from the National Health and Aging Trends Study, a nationally representative study of Medicare beneficiaries at age 65 years and older in the United States. Setting/Subjects: Analyses included proxies (N = 1336) of Medicare beneficiaries who passed away between 2013 and 2016. Proxies were categorized into four groups, depending on place of residence in the last month of life and the involvement of hospice. Measurements: Quality of EOL care was assessed using questions modeled after quality of EOL care instruments. We adjusted for demographic data of decedents and proxies. Results: Hospice recipients, regardless of setting, were more likely to experience pain and talk about religion in the last month of life; families of patients without hospice in residential care settings were more likely to report not being kept informed; proxies of patients living in private residences with hospice care reported higher overall ratings. Among hospice recipients, those living in private residences were more likely to be treated with respect. Conclusions: Disparities exist across settings and in overall ratings for quality of EOL domains - particularly, the subdomains of symptom management, decision making, and spiritual needs.
KW - home-based care
KW - hospice
KW - quality of end-of-life care
KW - residential care
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U2 - 10.1089/jpm.2019.0297
DO - 10.1089/jpm.2019.0297
M3 - Article
C2 - 32155358
AN - SCOPUS:85090290198
VL - 23
SP - 1198
EP - 1203
JO - Journal of Palliative Medicine
JF - Journal of Palliative Medicine
SN - 1096-6218
IS - 9
ER -