Disparities in end-of-life care : a retrospective study on intensive care utilization and advance care planning in the Colorado all-payer claims database

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HOLLADAY FORD, Darcy | LANDRY, Kimberly | JHA, Megha | MEYER, Martha

Background: Intensive end-of-life (EOL) care is emotionally and financially burdensome, disproportionally negatively impacting racial and ethnic minorities, rural residents, and lower socioeconomic seniors. Objectives: To evaluate the impact of race, ethnicity, and rural residency on EOL Intensive Care Unit (ICU) stays, emergency department (ED) visits, 30-day readmissions, and Advanced Care Planning (ACP) in Colorado residents when controlling for comorbidities. Methods:This retrospective cohort study analyzed data from the Colorado All-Payer Claims Database for 92,975 severely or chronically ill individuals (2018-2021). It used logistic regression models to evaluate associations between demographic variables and EOL health care utilization outcomes. Results:ICU Stays: Hispanic/Latino, Asian, and Black members had increased ICU stays compared to Whites (Adj. OR: 1.24;1.34;1.28: 95% CI). However, members without ACP and rural residents had lower ICU stays (Adj. OR: 0.67; 0.89: 95% CI). ED Visits: Hispanic/Latino, Asian, Black members, non-dually eligible members (Medicare Fee for Service (MFFS) + Medicaid), and rural residents had increased ED visits (Adj. OR: 1.29; 1.39; 1.19; 1.17; 2.04: 95% CI). Meanwhile, members without ACP or hospice care had lower ED visits (Adj. OR: 0.70; 0.75: 95% CI). 30-day Readmissions: Asian members and rural residents had increased 30-day readmissions (Adjusted OR: 2.42; 1.06: 95% CI). In contrast, those on MFFS and not on Medicaid, members without ACP, and those not in hospice care had decreased 30-day readmissions (Adj. OR: 0.69; 0.47; 0.83: 95% CI). Conclusion: EOL racial, geographic, and socioeconomic disparities exist in Colorado, requiring urgent interventions for a more equitable health care system.

http://dx.doi.org/10.1177/10499091251327191

Voir la revue «The American journal of hospice and palliative care»

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