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Health Serv Res. 2018 Dec;53(6):4291-4309. doi: 10.1111/1475-6773.12998. Epub 2018 Jun 27.

Regional Practice Patterns and Racial/Ethnic Differences in Intensity of End-of-Life Care.

Wang SY1,2, Hsu SH1,3, Huang S4,5, Doan KC6, Gross CP2,7, Ma X1,2.

Author information

1
Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT.
2
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT.
3
Schulich School of Business, York University, Toronto, ON, Canada.
4
Department of Biostatistics, Yale University School of Public Health, New Haven, CT.
5
Beijing PricewaterhouseCoopers Management Consulting (Shanghai) Limited, Beijing, China.
6
Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT.
7
Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.

Abstract

OBJECTIVE:

To examine whether regional practice patterns impact racial/ethnic differences in intensity of end-of-life care for cancer decedents.

DATA SOURCES:

The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database.

STUDY DESIGN:

We classified hospital referral regions (HRRs) based on mean 6-month end-of-life care expenditures, which represented regional practice patterns. Using hierarchical generalized linear models, we examined racial/ethnic differences in the intensity of end-of-life care across levels of HRR expenditures.

PRINCIPAL FINDINGS:

There was greater variation in intensity of end-of-life care among Hispanics, Asians, and whites in high-expenditure HRRs than in low-expenditure HRRs.

CONCLUSIONS:

Local practice patterns may influence racial/ethnic differences in end-of-life care.

KEYWORDS:

Racial differences; end-of-life care; geographic variation; regional practice patterns

PMID:
29951996
PMCID:
PMC6232508
[Available on 2019-12-01]
DOI:
10.1111/1475-6773.12998

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