• Lara Dhingra, Carla Braveman, Cordt Kassner, Clyde Schechter, Stephanie DiFiglia, and Russell Portenoy.
• MJHS Institute for Innovation in Palliative Care (L.D., S.D., R.P.), New York, New York, USA; Department of Family and Social Medicine (L.D., C.S., R.P.), Albert Einstein College of Medicine, New York, New York, USA. Electronic address: LDhingra@mjhs.org.
• J Pain Symptom Manage. 2022 Apr 1; 63 (4): 522-529.

ContextHospice utilization in New York State (NYS) is low compared to the rest of the U.S.ObjectivesThe first part of a mixed-methods study elicited information from New York State stakeholders and identified 54 hospice-related barriers in nine categories, some specific to NYS. This second part used national data to examine the differences between NYS and the rest of the country by evaluating the variables associated with low NYS hospice utilization.MethodsTen Medicare or publicly available datasets provided data from the year prior to death for all traditional Medicare-insured patients dying in 2018. Multivariate analyses identified variables independently associated with differences in hospice enrollment or length of stay between NYS and the rest of the country.ResultsThe NYS population was relatively older, included more women and minorities, had higher socioeconomic status (SES), and saw more physicians during the last two years of life. NYS had more physicians, more skilled nursing facility (SNF) beds, and fewer for-profit hospitals, SNFs, home care agencies, and hospice agencies. In multivariate analyses, lower NYS hospice utilization was associated with higher SES; more physicians seen during the last two years of life; more SNF beds and fewer for-profit SNF facilities; and fewer hospice agencies.ConclusionNYS's low hospice utilization is independently associated with diverse factors, including those related to the health care system. Combined with information from stakeholders, these findings may help target, and inform initiatives to improve hospice utilization.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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