• J Pain Symptom Manage · Nov 2013

    Targeted investment improves access to hospice and palliative care.

    • Amy P Abernethy, Janet Bull, Elizabeth Whitten, Rebecca Shelby, Jane L Wheeler, and Donald H Taylor.
    • Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina, USA; Department of Medicine, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: amy.abernethy@duke.edu.
    • J Pain Symptom Manage. 2013 Nov 1;46(5):629-39.

    ContextAvailability of hospice and palliative care is increasing, despite lack of a clear national strategy for developing and evaluating their penetration into and impact on the target population.ObjectivesTo determine whether targeted investment (i.e., strategic grants made by one charitable foundation) in hospice and palliative care in one U.S. state (North Carolina [NC]) led to improved access to end-of-life care services as indicated by hospice utilization.MethodsAccess was measured by the death service ratio (DSR), defined as the proportion of people who died and were served by hospice for at least one day before death. Calculation of the DSR is based on counts of patients accessing hospice by county in a given year (numerator) and U.S. Census projected population data for that county (denominator). Multilevel modeling was the primary analytic strategy used to generate two models: 1) comparison of the DSR in counties with vs. without philanthropic funding and 2) relationship between years since receipt of a philanthropic grant and DSR.ResultsIn NC, the average DSR increased from 20.7% in 2003 to 35.8% in 2009 (55% increase). In 2009, 82 of 100 NC counties had a DSR below the U.S. average (41.6%). In Model 1, significant associations were found between county population and DSR (P=0.03) and between receipt of philanthropic funding and DSR (P=0.01); on average, funded counties had a DSR that was 2.63 percentage points higher than unfunded counties.ConclusionReceipt of philanthropic funding appeared to be associated with improved access to palliative care and hospice services in NC.Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

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