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

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

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Asian / statistics & numerical data
  • Black People / statistics & numerical data
  • Ethnicity / statistics & numerical data*
  • Female
  • Health Expenditures / statistics & numerical data*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Insurance Claim Review
  • Male
  • Medicare / statistics & numerical data
  • Neoplasms / mortality
  • Referral and Consultation
  • SEER Program*
  • Terminal Care*
  • United States
  • White People / statistics & numerical data