Insurance Status and Ethnicity Impact Health Disparities in Rates of Advance Directives in Trauma

2021 ◽  
pp. 000313482110111
Author(s):  
Krista L. Haines ◽  
Benjamin P. Nguyen ◽  
Ioana Antonescu ◽  
Jennifer Freeman ◽  
Christopher Cox ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
End Of Life ◽  
Hospice Care ◽  
Private Insurance ◽  
Future Research ◽  
Trauma Patients ◽  
Improvement Program ◽  
Advanced Directives ◽  
Logistic Regression Models ◽  
Discharge Disposition

Introduction Advanced directives (ADs) provide a framework from which families may understand patient’s wishes. However, end-of-life planning may not be prioritized by everyone. This analysis aimed to determine what populations have ADs and how they affected trauma outcomes. Methods Adult trauma patients recorded in the American College of Surgeons Trauma Quality Improvement Program (TQIP) from 2013-2015 were included. The primary outcome was presence of an AD. Secondary outcomes included mortality, length of stay (LOS), mechanical ventilation, ICU admission/LOS, withdrawal of life-sustaining measures, and discharge disposition. Multivariable logistic regression models were developed for outcomes. Results 44 705 patients were included in the analyses. Advanced directives were present in 1.79% of patients. The average age for patients with ADs was 77.8 ± 10.7. African American (odds ratio (OR) .53, confidence intervals [CI] .36-.79) and Asian (OR .22, CI .05-.91) patients were less likely to have ADs. Conversely, Medicaid (OR 1.70, CI 1.06-2.73) and Medicare (OR 1.65, CI 1.25-2.17) patients were more likely to have ADs as compared to those with private insurance. The presence of ADs was associated with increased hospital mortality (OR 2.84, CI 2.19-3.70), increased transition to comfort measures (OR 2.87, CI 2.08-3.95), and shorter LOS (CO −.74, CI −1.26-.22). Patients with ADs had an increased odds of hospice care (OR 4.24, CI 3.18-5.64). Conclusion Advanced directives at admission are uncommon, particularly among African Americans and Asians. The presence of ADs was associated with increased mortality, use of mechanical ventilation, admission to the ICU, withdrawal of life-sustaining measures, and hospice. Future research should target expansion of ADs among minority populations to alleviate disparities in end-of-life treatment.

scholarly journals THE LAST MONTH OF LIFE: AN EXPLORATORY REVIEW OF THE NATIONAL HEALTH AND AGING TRENDS STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S274-S274
Author(s):  
Abigail Latimer ◽  
Lauren Montemuro-Rode ◽  
Brianna Garrison ◽  
Allison Gibson
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
National Health ◽  
Hospice Care ◽  
Influential Factors ◽  
Future Research ◽  
Time Of Death ◽  
Medicare Beneficiaries ◽  
Cross Sectional Survey ◽  
At Home

Abstract Approximately 80% of Americans prefer to die at home. Hospice and palliative care services are associated with improved pain and symptom management, increasing capacity to meet preferences for end-of-life care at home. However, according to the NHPCO (2018) only 48% of Medicare beneficiaries were enrolled in hospice at the time of death. This poster presents trends in the last month of life for adult Medicare beneficiaries age 65 or older examining the influential factors contributing to the quality of end-of-life experiences. A cross-sectional survey design was utilized with the National Health and Aging Trends Study (NHATS). Descriptive and inferential statistics were generated to describe a sample of persons (n= 241) who died in 2017. The sample demographics are predominately white (77.6%) females (61.4%) over 90 years old (42.4%). 29.5% of individuals died at home, 29.5% at the hospital, and 27% at a nursing home. Only 32.2% had hospice care in the last month, with many experiencing pain (71.1%), shortness of breath (54.7%), and anxiety/sadness (56.9%). There were 33.6% of participants who lived alone at death and 70% did not receive hospice care. The majority of these individuals were widowed (70.4%) and 33.3% died in the hospital. The other 28.4% died at their home or someone else’s and 25.9% died in a nursing home. Many older adults face multiple barriers to experiencing a quality end-of-life experience. Future research should examine the challenges facing those living alone at time of death.

The DEPARTS Score: A Novel Tool for Predicting Discharge Disposition in Geriatric Trauma Patients

2021 ◽  
pp. 000313482110298
Author(s):  
Eric O. Yeates ◽  
Areg Grigorian ◽  
Catherine M. Kuza ◽  
Ninh T. Nguyen ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Acute Care ◽  
Weighted Average ◽  
Functional Health ◽  
Geriatric Trauma ◽  
Receiver Operating Curve ◽  
High Risk Population ◽  
Trauma Patients ◽  
Improvement Program ◽  
Discharge Disposition ◽  
Cord Injury

Background Geriatric trauma patients (GTPs) represent a high-risk population for needing post-acute care, such as skilled nursing facilities (SNFs) and long-term acute care hospitals (LTACs), due to a combination of traumatic injuries and baseline functional health. As there is currently no well-established tool for predicting these needs, we aimed to create a scoring tool that predicts disposition to SNFs/LTACs in GTPs. Methods The adult 2017 Trauma Quality Improvement Program database was divided at random into two equal sized sets (derivation and validation sets) of GTPs >65 years old. First, multiple logistic regression models were created to determine risk factors for discharge to a SNF/LTAC in admitted GTPs. Second, the weighted average and relative impact of each independent predictor was used to derive a DEPARTS ( Discharge of Elderly Patients After Recent Trauma to SNF/LTAC) score. We then validated the score using the area under the receiver-operating curve (AROC). Results Of 66 479 patients in the derivation set, 36 944 (55.6%) were discharged to a SNF/LTAC. Number of comorbidities, fall mechanism, spinal cord injury, long bone fracture, and major surgery were each independent predictors for discharge to SNF/LTAC, and a DEPARTS score was derived with scores ranging from 0 to 19. The AROC for this was .74. In the validation set, 66 477 patients also had a SNF/LTAC discharge rate of 55.7%, and the AROC was .74. Discussion The DEPARTS score is a good predictor of SNF/LTAC discharge for GTPs. Future prospective studies are warranted to validate its accuracy and clinical utility in preventing delays in discharge.

scholarly journals PREVALENCE AND CORRELATES OF SYMPTOMS OF ANXIETY AND DEPRESSION AT THE VERY END OF LIFE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S669-S669
Author(s):  
Elissa K Kozlov ◽  
Veerawat Phongtankuel ◽  
Cary Reid
Keyword(s):  
End Of Life ◽  
Symptom Management ◽  
Hospice Care ◽  
Psychological Symptoms ◽  
Psychological Symptom ◽  
Symptom Assessment ◽  
Anxiety And Depression ◽  
Future Research ◽  
Cross Sectional ◽  
Edmonton Symptom Assessment Scale

Abstract Rates of psychological symptoms for patients with serious illness is high, but there has been limited research investigating psychological symptoms at the very end of life. The aim of this study was to better understand the prevalence, intensity and correlates of psychological distress at the very end of life. This cross-sectional study utilized caregiver proxy interviews. Caregivers were contacted after their loved one recently died after being on home hospice and invited to participate in a brief interview with a trained research assistant. Patient, caregiver and hospice utilization data were also abstracted from electronic medical records. N = 351 caregivers were included in the study. According to caregivers, 46.4% of patients had moderate to severe anxiety, as assessed with a score of ≥4 on the Edmonton Symptom Assessment Scale (ESAS) and 43% had moderate to severe symptoms of depression in the last week of life. Symptoms of anxiety and depression were significantly associated with caregiver burden scores and inversely associated with the age of the patient. Psychological symptom management at the very end of life is essential to providing comprehensive hospice care. Our study revealed that nearly half of patients die with moderate to severe symptoms of anxiety and/or depression. Future research is needed to improve psychological symptom management at the very end of life in order to improve the quality of life for both patients and their families.

Race and Insurance Status Disparities in Post-discharge Disposition After Hospitalization for Major Trauma

2021 ◽  
pp. 000313482110298
Author(s):  
Adel Elkbuli ◽  
Mason Sutherland ◽  
Toria Gargano ◽  
Kyle Kinslow ◽  
Huazhi Liu ◽  
...  
Keyword(s):  
Secondary Care ◽  
Injury Severity ◽  
Care Facility ◽  
Future Research ◽  
Primary Study ◽  
Insurance Status ◽  
Improvement Program ◽  
Term Care ◽  
Discharge Disposition ◽  
Black Patients

Background Investigations detailing predictive measures of hospital disposition after traumatic injury are scarce. We aim to examine the discharge practices among trauma centers in the US and to identify factors that may influence post-hospital disposition. Methods A retrospective analysis of trauma patients using the American College of Surgeons-Trauma Quality Improvement Program dataset from 2007-2017. Primary study outcome was hospital disposition (including long term care facility [LTC], others). Secondary outcomes included: Intensive Care Unit (ICU)-length of stay (LOS), complications, others). Results 6 899 538 patients were analyzed. Odds of LTC discharge was significantly higher for Black patients (aOR = 1.30, 95% CI:1.24-1.37), abbreviated injury score (AIS) ≥3 (aOR = 4.22, 95% CI: 4.05-4.39), and higher injury severity score (ISS) (aOR = 9.41, 95% CI:9.03-9.80). Significantly more self-pay patients were discharged home compared to other insurance types ( P < .0001). Significantly longer hospital- and ICU-LOS were experienced by those who had an AIS ≥3 (hospital: 4.8 days (±7.1) vs. 7.9 (±10.1); ICU: 4.6 (±6.9) vs. 5.9 (±7.9), P < .0001) and had a high ISS (hospital: 4.5 days (±5.9) vs. 16.8 (±17.9); ICU: 3.6 (±5.0) vs. 10.2 (±11.5), P < .0001). Conclusions Patient race, insurance status, and injury severity were predictive of post-hospitalization care discharge. Self-pay and Black patients were less likely to be discharged to secondary care facilities. These findings have the potential to improve in-hospital patient management and predict discharge secondary care needs, and necessitate the need for future research to investigate the extent of inequalities in access to trauma care.

Dying to Know: A Community Survey about Dying and End-of-Life Care

2010 ◽  
Vol 60 (1) ◽  
pp. 33-50 ◽  
Author(s):  
Susan L. Schrader ◽  
Margot L. Nelson ◽  
LuAnn M. Eidsness
Keyword(s):  
South Dakota ◽  
End Of Life ◽  
Sex Education ◽  
Professional Education ◽  
End Of Life Care ◽  
Hospice Care ◽  
Community Survey ◽  
Future Research ◽  
Community Studies ◽  
Eol Care

A community survey of Sioux Falls, South Dakota was conducted in 2004 to understand knowledge, attitudes, and preferences about end-of-life (EOL) care and to generate conversations about these topics. Questionnaires were sent to 5,000 randomly selected households, with a return of 1,042 (21%). Most respondents said preparation for EOL is very important, yet far fewer had taken steps to ensure their EOL wishes would be known or met. These disparities are examined, with recommendations for future research and public policy. Bivariate analyses revealed significant differences by age, sex, education, marital status, and religiosity. Community studies are important for baseline understanding, evoking conversation, and setting goals for change. Public education is needed to strengthen understandings of hospice care, and professional education is needed to raise awareness about practitioners' roles in resolving discrepancies between what people want and what they get at end of life.

Prehospital Variables Alone Can Predict Mortality After Blunt Trauma: A Novel Scoring Tool

2021 ◽  
pp. 000313482110241
Author(s):  
Stephen Stopenski ◽  
Areg Grigorian ◽  
Kenji Inaba ◽  
Michael Lekawa ◽  
Kazuhide Matsushima ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Vital Signs ◽  
Weighted Average ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Improvement Program ◽  
Logistic Regression Models ◽  
Revised Trauma Score ◽  
Activation Criterion ◽  
Scoring Tool

Background We sought to develop a novel Prehospital Injury Mortality Score (PIMS) to predict blunt trauma mortality using only prehospital variables. Study Design The 2017 Trauma Quality Improvement Program database was queried and divided into two equal sized sets at random (derivation and validation sets). Multiple logistic regression models were created to determine the risk of mortality using age, sex, mechanism, and trauma activation criterion. The PIMS was derived using the weighted average of each independent predictor. The discriminative power of the scoring tool was assessed by calculating the area under the receiver operating characteristics (AUROC) curve. The PIMS ability to predict mortality was then assessed by using the validation cohort. The score was compared to the Revised Trauma Score (RTS) using the AUROC curve, including a subgroup of patients with normal vital signs. Results The derivation and validation groups each consisted of 163 694 patients. Seven independent predictors of mortality were identified, and the PIMS was derived with scores ranging from 0 to 20. The mortality rate increased from 1.4% to 43.9% and then 100% at scores of 1, 10, and 19, respectively. The model had very good discrimination with an AUROC of .79 in both the derivation and validation groups. When compared to the RTS, the AUROC were similar (.79 vs. .78). On subgroup analysis of patients with normal prehospital vital signs, the PIMS was superior to the RTS (.73 vs. .56). Conclusion The PIMS is a novel scoring tool to predict mortality in blunt trauma patients using prehospital variables. It had improved discriminatory power in blunt trauma patients with normal vital signs compared to the RTS.

Integrative Review of the Literature on Hispanics and Hospice

2017 ◽  
Vol 35 (3) ◽  
pp. 542-554 ◽  
Author(s):  
Margaret L. Rising ◽  
Dena S. Hassouneh ◽  
Kristin F. Lutz ◽  
Chris S. Lee ◽  
Pat Berry
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Research Literature ◽  
Integrative Review ◽  
Future Research ◽  
Life Care ◽  
Hispanic Culture ◽  
Cultural Considerations ◽  
Socioeconomic Considerations

The provision of optimal end-of-life care to Hispanics receiving hospice care requires familiarity with hospice-specific variables. For example, a preference for nondisclosure of terminal prognosis in some Hispanics is incongruous with traditional hospice practice. In addition, the Spanish word for hospice, “hospicio,” has negative connotations about abandonment of loved ones. Added to cultural considerations are socioeconomic considerations. Many marginalized Hispanic individuals may experience distinct challenges when enrolling in hospice due to socioeconomic hardships relating to poverty, citizenship, and lack of insurance. This systematic integrative review examines the research literature on Hispanics and hospice to report on the state of the science for this topic. Reviewed articles were identified systematically using computer research databases and inclusion and exclusion criteria. Of the 21 reviewed articles, many are survey and low-inference qualitative designs with limited validity and trustworthiness. Most survey instruments were not validated for Spanish language or Hispanic culture. None of the qualitative studies included theoretical sampling or follow-up interviews. Few study designs considered heterogeneity within the Hispanic population. Interpreting results cautiously, there is evidence that some Hispanics find some satisfaction with hospice care in spite of cultural incongruities and socioeconomic challenges. Future research calls for intervention studies and high-inference qualitative designs to gain insight into hospice experiences and what constitutes quality hospice care from the perspectives of Hispanic subgroups. Assessing quality and designing interventions for these end-of-life cultural and socioeconomic issues will improve end-of-life care and facilitate the hospice philosophy of promoting emotional growth at end of life.

Hospice use at end of life in children with cancer: The effect of insurance.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10558-10558
Author(s):  
Emily E. Johnston ◽  
Elizabeth Davis ◽  
Smita Bhatia ◽  
Kelly Kenzik
Keyword(s):  
End Of Life ◽  
Hospice Care ◽  
Private Insurance ◽  
Hematologic Malignancies ◽  
Insurance Status ◽  
Children With Cancer ◽  
Location Of Death ◽  
National Quality ◽  
Eol Care ◽  
Privately Insured

10558 Background: The National Quality Forum has endorsed hospice care as a metric of high quality end-of-life (EOL) care for adults with cancer. Specific hospice-related quality metrics include hospice enrollment, hospice enrollment for ≥3d, and death outside of the acute care setting. These metrics have been examined extensively in adults and disparities related to a number of clinical and sociodemographic factors, including insurance, have been identified. However, for children with cancer, hospice utilization data is lacking. We addressed this gap by examining location of death and hospice utilization at EOL for children with cancer and determining whether these metrics varied with insurance status. Methods: We used national insurance claims data (Truven) to conduct a population-based analysis of patients with cancer who died between 2011 and 2017 at age 0-21y. The dataset was queried for hospice claims, inpatient claims, and location of death. The association between insurance (private vs. Medicaid) and 1) location of death, 2) hospice enrollment, and 3) days between first hospice claim and death was examined using multivariable regression analysis, adjusting for age at death, gender, and cancer diagnosis (hematologic malignancies vs. solid tumor). Results: A total of 1,492 children died at a mean age of 11y (SD: 6y); 56% were privately-insured, 56% were male, and 30% had hematologic malignancies. Overall, 58% died in the hospital (privately-insured: 54% vs. Medicaid: 63%). Forty-five percent enrolled in hospice (privately-insured: 46% vs. Medicaid: 43%) with 2% returning to the hospital to die after enrolling in hospice. The average time between first hospice claim and death was 3d (privately-insured: 10d vs. Medicaid: 2d, p = < 0.001). When compared to privately-insured children, children on Medicaid had similar likelihood of hospice enrollment (RR = 1.0, 95%Cl = 0.6-1.8). However, children on Medicaid were more likely to die in the hospital (RR = 1.3, 95%CI = 1.1-1.4) and have fewer days between hospice enrollment and death if enrolled in hospice (IRR: 0.5, 95%CI = 0.3-0.8). Conclusions: In this first study to examine national hospice utilization in children with cancer, care varies significantly with insurance status. Children on Medicaid are more likely to die in the hospital and have shorter hospice enrollment duration than children with private insurance. Whether this variation represents EOL care preferences, provider biases, differences in quality and availability of hospice or home care to different insurers, or other barriers needs to be examined.

scholarly journals The Use and Effectiveness of Advanced Directives in the End of Life Care of Trauma Patients

2015 ◽  
Vol 221 (4) ◽  
pp. S84-S85
Author(s):  
Ali Darehzereshki ◽  
Shahram Aarabi ◽  
Samuel P. Mandell ◽  
Frederick P. Rivara ◽  
J. Randall Curtis ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Trauma Patients ◽  
Life Care ◽  
Advanced Directives

Dysphagia in Hospice Care: The Roles of Social Work and Speech-Language Pathologists

2014 ◽  
Vol 23 (4) ◽  
pp. 173-186 ◽  
Author(s):  
Deborah Hinson ◽  
Aaron J. Goldsmith ◽  
Joseph Murray
Keyword(s):  
Social Work ◽  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Hospice Care ◽  
Patient Communication ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Four Levels

This article addresses the unique roles of social work and speech-language pathologists (SLPs) in end-of-life and hospice care settings. The four levels of hospice care are explained. Suggested social work and SLP interventions for end-of-life nutrition and approaches to patient communication are offered. Case studies are used to illustrate the specialized roles that social work and SLP have in end-of-life care settings.

Sign in / Sign up

Export Citation Format

Share Document