Goals-of-Care Consultation Associated With Increased Hospice Enrollment Among Propensity-Matched Cohorts of Seriously Ill African American and White Patients

Abstract Early palliative care consultation to discuss goals-of-care (“PCC”) benefits seriously ill patients. To identify risk factor profiles associated with inpatient PCC timing before death, we conducted a secondary analysis of seriously ill adults who had PCC at a high-acuity hospital and died 2014-2016. Of 1,141 patients, 54% had PCC “close to death” (0-14 days before death); 26% had PCC 15-60 days before death; 21% had PCC >60 days before death (median 13 days). Classification and Regression Tree modeling showed Hispanic or “Other” race/ethnicity intensive care patients with extreme illness severity (85%) were most likely to have PCC close to death, with age <46 or >75 increasing probability (98%). Among age groups, the highest proportion of patients with PCC close to death was >75 years. Complex variable interactions associated with PCC timing suggests we need a systematic process for initiating PCC earlier and effective primary palliative training for providers across settings.

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African American patients with surgically managed ectopic pregnancy are less likely than white patients to be offered salpingostomy

Fertility and Sterility ◽

10.1016/j.fertnstert.2018.07.768 ◽

2018 ◽

Vol 110 (4) ◽

pp. e270-e271

Author(s):

J.A. Gingold ◽

I. Janmey ◽

L. Gemmell ◽

L.D. Bradley ◽

T. Falcone

Keyword(s):

African American ◽

Ectopic Pregnancy ◽

White Patients

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A National Pilot of Goals of Care Conversations for Seriously Ill Veterans: Patient and Site Variation and Associations with Bereaved Family Survey Outcomes (TH323D)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2019.12.067 ◽

2020 ◽

Vol 59 (2) ◽

pp. 422

Author(s):

Marie Haverfield ◽

Ariadna Garcia ◽

Joseph Rigdon ◽

Karleen Giannitrapani ◽

Anne Walling ◽

...

Keyword(s):

Goals Of Care ◽

Site Variation ◽

Bereaved Family ◽

Seriously Ill

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Differences in Risk Factors for Suicidality Between African American and White Patients Vulnerable to Suicide

Suicide and Life-Threatening Behavior ◽

10.1521/suli.2007.37.1.1 ◽

2007 ◽

Vol 37 (1) ◽

pp. 1-9 ◽

Cited By ~ 24

Author(s):

Lauren C. Vanderwerker ◽

Joyce H. Chen ◽

Peter Charpentier ◽

Mary Elizabeth Paulk ◽

Marion Michalski ◽

...

Keyword(s):

Risk Factors ◽

African American ◽

White Patients

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Advanced Emphysema in African-American and White Patients

CHEST Journal ◽

10.1378/chest.130.1.108 ◽

2006 ◽

Vol 130 (1) ◽

pp. 108-118 ◽

Cited By ~ 30

Author(s):

Wissam M. Chatila ◽

Eric A. Hoffman ◽

John Gaughan ◽

G. Blake Robinswood ◽

Gerard J. Criner

Keyword(s):

African American ◽

White Patients

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Abstract WP178: Acute Stroke Ischemic Symptom Onset-to-Arrival Time in Michigan Hospitals

Stroke ◽

10.1161/str.47.suppl_1.wp178 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Muhammad U Farooq ◽

Kathie Thomas

Keyword(s):

African American ◽

Ischemic Stroke ◽

Acute Stroke ◽

Patient Outcomes ◽

Symptom Onset ◽

Arrival Time ◽

Heart Association ◽

The United States ◽

Stroke Patients ◽

White Patients

Objectives: Stroke is the fifth-leading cause of death and the leading cause of disability in the United States. One of the primary goals of the American Heart Association/American Stroke Association is to increase the number of acute stroke patients arriving at emergency departments (EDs) within 1-hour of symptom onset. Earlier treatment with thrombolysis in patients with acute ischemic stroke translates into improved patient outcomes. The objective of this abstract is to examine the association between the use of emergency medical services (EMS) and symptom onset-to-arrival time in patients with ischemic stroke. Methods: A retrospective review of ischemic stroke patients (n = 8873) from 25 Michigan hospitals from January 2012-December 2014 using Get With the Guidelines databases was conducted. Symptom onset-to-ED arrival time and arrival mode were examined. Results: It was found that 17.4% of ischemic stroke patients arrived at the hospitals within 1-hour of symptom onset. EMS transported 69.1% of patients who arrived within 1-hour of symptom onset. During this 1-hour period African American patients (22%) were less likely to use EMS transportation as compared to White patients (72%). The majority of patients, 41.8%, arrived after 6-hours of symptom onset. EMS transported only 40% of patients who arrived after 6-hours of symptom onset. As before, during this 6-hour period African American patients (20%) were also less likely to use EMS transportation as compared to White patients (75%). Symptom onset-to-ED arrival time was shorter for those patients who used EMS. The median pre-hospital delay time was 2.6 hours for those who used EMS versus 6.2 hours for those who did not use EMS. Conclusions: The use of EMS is associated with a decreased pre-hospital delay, early treatment with thrombolysis and improved patient outcomes in ischemic stroke patients. Community interventions should focus on creating awareness especially in minority populations about stroke as a neurological emergency and encourage EMS use amongst stroke patients.

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Effect of Race and Ethnicity on In-Hospital Mortality in Patients with COVID-2019

Ethnicity & Disease ◽

10.18865/ed.31.3.389 ◽

2021 ◽

Vol 31 (3) ◽

pp. 389-398

Author(s):

Adnan I. Qureshi ◽

William I. Baskett ◽

Wei Huang ◽

Daniel Shyu ◽

Danny Myers ◽

...

Keyword(s):

Palliative Care ◽

African American ◽

Hospital Mortality ◽

Race And Ethnicity ◽

Pacific Islander ◽

Sociodemographic Factors ◽

Secondary Outcome ◽

Do Not Resuscitate ◽

Short Term ◽

White Patients

Objective: To identify differences in short-term outcomes of patients with coronavirus disease 2019 (COVID-19) according to various racial/ethnic groups.Design: Analysis of Cerner de-identified COVID-19 dataset.Setting: A total of 62 health care facilities.Participants: The cohort included 49,277 adult COVID-19 patients who were hospitalized from December 1, 2019 to November 13, 2020.Methods: We compared patients’ age, gender, individual components of Charlson and Elixhauser comorbidities, medical complications, use of do-not-resuscitate, use of palliative care, and socioeconomic status between various racial and/or ethnic groups. We further compared the rates of in-hospital mortality and non-routine discharges between various racial and/or ethnic groups.Main Outcome Measures: The primary outcome of interest was in-hospital mortality. The secondary outcome was non-routine discharge (discharge to destinations other than home, such as short-term hospitals or other facilities including intermediate care and skilled nursing homes).Results: Compared with White patients, in-hospital mortality was significantly higher among African American (OR 1.5; 95%CI:1.3-1.6, P<.001), Hispanic (OR1.4; 95%CI:1.3-1.6, P<.001), and Asian or Pacific Islander (OR 1.5; 95%CI: 1.1-1.9, P=.002) patients after adjustment for age and gender, Elixhauser comorbidities, do-not-resuscitate status, palliative care use, and socioeconomic status.Conclusions: Our study found that, among hospitalized patients with COVID-2019, African American, Hispanic, and Asian or Pacific Islander patients had increased mortality compared with White patients after adjusting for sociodemographic factors, comorbidities, and do-not-resuscitate/palliative care status. Our findings add additional perspective to other recent studies. Ethn Dis. 2021;31(3):389-398; doi:10.18865/ed.31.3.389

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Race, age, and gender influences among clusters of african american and white patients with chronic pain

Journal of Pain ◽

10.1016/j.jpain.2004.02.227 ◽

2004 ◽

Vol 5 (3) ◽

pp. 171-182 ◽

Cited By ~ 68

Author(s):

C Green

Keyword(s):

Chronic Pain ◽

African American ◽

Age And Gender ◽

And Gender ◽

Gender Influences ◽

White Patients

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Differential Prescription of Maintenance Antipsychotics to African American and White Patients With New-Onset Bipolar Disorder

The Journal of Clinical Psychiatry ◽

10.4088/jcp.v63n0802 ◽

2002 ◽

Vol 63 (8) ◽

pp. 658-664 ◽

Cited By ~ 28

Author(s):

David E. Fleck ◽

Wendi L. Hendricks ◽

Melissa P. DelBello ◽

Stephen M. Strakowski

Keyword(s):

Bipolar Disorder ◽

African American ◽

New Onset ◽

White Patients

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Pilot of the Life-Sustaining Treatment Decisions Initiative Among Veterans With Serious Illness

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120923595 ◽

2020 ◽

Vol 38 (1) ◽

pp. 68-76

Author(s):

Karleen F. Giannitrapani ◽

Anne M. Walling ◽

Ariadna Garcia ◽

MaryBeth Foglia ◽

Jill S. Lowery ◽

...

Keyword(s):

Treatment Decisions ◽

Department Of Veterans Affairs ◽

Do Not Resuscitate ◽

Policy And Practice ◽

Goals Of Care ◽

Chart Abstraction ◽

Integrated Health Care System ◽

Life Sustaining Treatment ◽

Seriously Ill Patients ◽

Seriously Ill

Background: Prior to national spread, the Department of Veterans Affairs implemented a pilot of the life-sustaining treatment decisions initiative (LSTDI) to promote proactive goals of care conversations (GoCC) with seriously ill patients, including policy and practice standards, an electronic documentation template and order set, and implementation support. Aim: To describe a 2-year pilot of the LSTDI at 4 demonstration sites. Design: Prospective observational study. Setting/Participants: A total of 6664 patients who had at least one GoCC. Results: Descriptive statistics characterized patient demographics, goals of care, LST decisions, and risk of hospitalization or mortality among patients with at least one GoCC. Participants were on average 71.4 years old, 93.2% male, 87.1% white, and 64.7% urban; 27.3% died by the end of the pilot period. Fifteen percent lacked decision-making capacity (DMC). Nonmutually exclusive goals included to be cured (7.6%), to prolong life (34%), to improve/maintain quality of life (61.5%), to be comfortable (53%), to obtain support for family/caregiver (8.4%), to achieve life goals (2.1%), and other (10.5%). Many GoCCs resulted in a do not resuscitate (DNR) order (58.8%). Patients without DMC were more likely to have comfort-oriented goals (77.3% vs 48.8%) and a DNR (84% vs 52.6%). Chart abstraction supported content validity of GoCC documentation. Conclusion: The pilot demonstrated that standardizing practices for eliciting and documenting GoCCs resulted in customized documentation of goals of care and LST decisions of a large number of seriously ill patients and established the feasibility of spreading standardized practices throughout a large integrated health care system.

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