Access to hospice care fails to explain disparities in enrollment

Disparities in hospice use among patients are not likely due to lack of access, according to a study published in the Journal of Palliative Medicine.

Using data from the 2008 Medicare Provider of Services data, US Census data, and geographic mapping software, Melissa Carlson, PhD, assistant professor of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine, and her colleagues conducted a cross-sectional study of geographic access to US hospices.

According to background information provided by the study's authors, enrollment in hospice is shown to help address end-of-life concerns facing patients and their caregivers.

The results of the study revealed that 98% of the US population lives in communities within 60 minutes of a hospice provider, and 88% live within 30 minutes of one. “Despite a significant increase in the availability of hospice services during the past decade, the majority of Americans die without hospice care,” said Dr. Carlson. “Our data show that proximity to a hospice provider is not a likely barrier to hospice enrollment, as the vast majority of Americans have a hospice nearby.” The study's authors say that the results of the study suggest that disparities in use of hospice are not likely due to lack of access to a hospice provider.

"Our data suggest that the growth in the number of hospices since 2000 has improved access to hospice care as the closest hospice for approximately one-third of the population, in both rural and urban areas, is a relatively new hospice, certified by Medicare since 2000," said Dr. Carlson. "However, more research is needed to determine why more patients and their families are not under the care of a hospice at the end of life, including hospice admission criteria and patient financial and cultural factors that may present barriers to hospice use."

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