National Healthcare Disparities Report - LDI Health Economist

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Effectiveness of Care Chapter 2 Supportive and Palliative Care n The 2008 top 5 State achievable benchmark for high-risk long-stay residents was 7%. xxxix At the current 2% annual rate of decrease, this benchmark could be attained overall in about 12 years. Whites could achieve the benchmark in about 9 years. Blacks, APIs, AI/ANs, and Hispanics would take between 15 and 19 years to attain this benchmark. Also, in the NHQR: n From 2000 to 2009, the rate of short-stay residents with pressure sores fell. The rate also fell for high-risk long-stay residents. Improvements included lower rates for both males and females. n Short-stay residents have higher rates of pressure sores than high-risk long-stay residents. Some of these patients may be admitted to nursing homes because of or with sores acquired during an acute care hospitalization. n In all years, males were more likely than females to have pressure sores. Help With Emotional and Spiritual Needs Hospice care is generally delivered at the end of life to patients with a terminal illness or condition who desire palliative medical care; it also includes practical, psychosocial, and spiritual support for the patient and family. The goal of end-of-life care is to achieve a “good death,” defined by the IOM as one that is “free from avoidable distress and suffering for patients, families, and caregivers; in general accord with the patients’ and families’ wishes; and reasonably consistent with clinical, cultural, and ethical standards” (Field & Cassell, 1997). The National Hospice and Palliative Care Organization’s Family Evaluation of Hospice Care survey examines the quality of hospice care for dying patients and their family members. Family respondents report how well hospices respect patients’ wishes, communicate about illness, control symptoms, support dying on one’s own terms, and provide family emotional support. xl Management: Right Amount of Emotional Support Among Hospice Patients Dying is stressful. Patients at the end of life may develop depression or anxiety disorders. Health care systems and providers need to be attuned to recognizing and responding to the emotional and spiritual needs of patients with life-limiting illness and their families. xxxix The top 5 States that contributed to the achievable benchmark are Hawaii, Minnesota, Nebraska, New Hampshire, and North Dakota. xl This survey provides unique insight into end-of-life care and captures information about a large percentage of hospice patients but is limited by nonrandom data collection and a response rate of about 40%. Survey questions were answered by family members, who might not be fully aware of the patients’ wishes and concerns. These limitations should be considered when interpreting these findings. 130 National Healthcare Disparities Report, 2011
Effectiveness of Care Figure 2.57. Hospice patients age 18 and over who did NOT receive the right amount of help for feelings of anxiety or sadness, by race and ethnicity, 2008-2010 25 White Black API AI/AN 25 Non-Hispanic White Hispanic 20 20 Percent 15 10 5 0 Key: AI/AN = American Indian or Alaska Native; API = Asian or Pacific Islander. Source: National Hospice and Palliative Care Organization, Family Evaluation of Hospice Care, 2008-2010. Denominator: Adult hospice patients. Note: For this measure, lower rates are better. n In all years, Blacks, APIs, and AI/ANs were less likely than Whites and Hispanics were less likely than non-Hispanic Whites to receive the right amount of emotional support (Figure 2.57). n The 2009 top 5 State achievable benchmark was 6%. xli Data are insufficient to assess progress toward this goal. Also, in the NHQR: 2009 Achievable Benchmark: 6% 2008 2009 2010 n The percentage of hospice patients whose families reported that they did not receive the right amount of help for feelings of anxiety or sadness was 10% in 2010. n Between 2008 and 2010, hospice patients ages 18-44 and 45-64 were less likely than patients age 65 and over to receive the right amount of emotional support. Percent 15 10 5 0 2009 Achievable Benchmark: 6% 2008 2009 2010 Chapter 2 Supportive and Palliative Care Effective Communication Management: Enough Information About What To Expect Among Hospice Family Caregivers Patients at the end of life and their families need clear information about treatment options, prognosis, and advance directives, and what to expect while the patient is dying. Health care providers need to be skilled at eliciting patient’s values and preferences, accepting of different cultural and religious choices, and committed to continuing care regardless of patient treatment decisions. xli The top 5 States contributing to the achievable benchmark are Alabama, Alaska, Arkansas, Kansas, and South Carolina. National Healthcare Disparities Report, 2011 131
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