• Jennifer Kapo, Holly MacMoran, and David Casarett.
• University of Pennsylvania, Department of Medicine Division of Geriatrics and the Institute on Aging, Philadelphia Veterans Affairs Medical Center, USA. Jennifer.Kapo@uphs.upenn.edu
• J Palliat Med. 2005 Jun 1; 8 (3): 603608603-8.

BackgroundHospice has become the major provider of comprehensive end-of-life care in the United States, but is underutilized by African American patients. It is likely that whatever factors are responsible for lower rates of hospice utilization among African Americans also lead to lower rates of return to hospice after discharge, but this is not known.ObjectiveTo determine whether African American patients who leave hospice are less likely to return before death.DesignRetrospective cohort study.SettingUniversity-affiliated hospice.ParticipantsAll patients discharged after a first admission.MeasurementsAll patient characteristics were defined by abstraction of electronic medical records at the time of hospice discharge.ResultsOf 358 discharged patients, 98 (27%) were decertified and 260 (73%) left voluntarily. Ninety-six patients returned to hospice during the study period. In bivariate analysis, African Americans were less likely to return than were other patients (odds ratio (OR) 0.47, 95% CI: 0.28-0.80; p = .005). In a multivariable logistic regression model, African American ethnicity was independently associated with a decreased likelihood of return.ConclusionsEthnic disparities in hospice utilization may extend even to those patients who do enroll in hospice. African Americans who leave hospice during their first admission and their families may be less likely to have access to the comprehensive services that hospice programs provide near the end of life, including intensive nursing care, pain and symptom management, and education.

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