Neighborhood Sociodemographic and Economic Characteristics as Predisposing Factors for Live Discharge among Hospice Recipients

• In Event: 4411 - Challenges and Barriers in Health Care Delivery

Abstract

Although hospice care is associated with improved quality of life for dying individuals and their families, approximately one in five hospice patients is discharged prior to death ("live discharge"), an often burdensome outcome. Guided by the Andersen model of health service utilization, this paper examines how neighborhood-level socio-demographic and economic contexts operate as predisposing factors for four types of live discharge from hospice. Using hospice records from 2013-2017 from a large hospice provider, we identify geographic hot spots for live discharge in the New York City area based on measures of neighborhood characteristics obtained from publicly available data on 55 New York City neighborhoods. Results indicate that neighborhood affluence and particular types of demographic homophily (large proportion of white or native-born residents) is protective against live discharge and elective revocation. Residing in neighborhoods that are in the midpoint economically is protective against disqualification, while residing in neighborhoods at the midpoint in terms of proportion of Black residents increases risk of disqualification. Our analyses suggest that neighborhood-level factors operate in different ways with respect to distinct reasons for live hospice discharge.

Authors

• David Russell, Appalachian State University

• Elizabeth Anne Luth, Weill Cornell Medical College