3035 — Racial and Ethnic Disparities in End of Life Care Among Veterans

Kutney-Lee A, VA PROMISE Center; Gilbert D, VA PROMISE Center; Thorpe J, VA PROMISE Center; del Rosario C, VA PROMISE Center; Ersek M, VA PROMISE Center;

Objectives:
Racial/ethnic disparities in the receipt of quality healthcare are well-documented in the United States, including the Veterans Affairs (VA) healthcare system. Some reports suggest that the disparities gap is closing, while others have found that inequalities remain in many clinical contexts. Few studies have explored disparities in the quality and outcomes of care received at the end of life (EOL), particularly among Veterans. The objective of this national study was to examine and compare the quality of EOL care received by Veterans and their families across racial/ethnic groups.

Methods:
A retrospective, cross-sectional analysis of chart review and Bereaved Family Survey (BFS) data from October 2009 to September 2014 was performed. Charts were reviewed for all inpatient deaths in VA Medical Centers during the study years (n = 94,687) and were examined for four indicators of high-quality EOL care, including receipt of a palliative care consult. BFS data were collected from deceased Veterans' family members (n = 51,859) and included 14 items related to perceptions of EOL care (e.g. pain management), as well as a global measure of overall quality. Race/ethnicity was measured via chart review and was defined as White, Black, Hispanic, or other. Robust logistic regression models that accounted for patient and hospital characteristics, and survey non-response were used to examine relationships.

Results:
Among EOL quality indicators, Black Veterans were 17% less likely to receive a palliative care consult (p < 0.05) and 18% less likely to have a documented chaplain note (p < 0.05). Among BFS outcomes, disparities were noted for Blacks on 12 of 15 measures. The racial difference on the global item was particularly striking"” the odds of families giving an overall excellent rating for EOL care was 44% lower for Black Veterans as compared to Whites (p < 0.05). Disparities for Hispanic Veterans and other minority groups were observed for 8 and 6 BFS items, respectively.

Implications:
Marked racial/ethnic disparities exist in the quality and outcomes of EOL care received by Veterans. Our results suggest that tailored, culturally-sensitive interventions are needed to improve care.

Impacts:
This is the first study to document racial/ethnic disparities in quality of EOL care in the VA.