Background: Hospice has become the major provider of comprehensive end-of-life care in the
United States, but is underutilized by African American patients. It is likely that whatever
factors are responsible for lower rates of hospice utilization among African Americans also
lead to lower rates of return to hospice after discharge, but this is not known.
Objective: To determine whether African American patients who leave hospice are less
likely to return before death.
Design: Retrospective cohort study.
Setting: University-affiliated hospice.
Participants: All patients discharged after a first admission.
Measurements: All patient characteristics were defined by abstraction of electronic medical
records at the time of hospice discharge.
Results: Of 358 discharged patients, 98 (27%) were decertified and 260 (73%) left voluntarily.
Ninety-six patients returned to hospice during the study period. In bivariate analysis,
African Americans were less likely to return than were other patients (odds ratio (OR) 0.47,
95% CI: 0.28–0.80; p = .005). In a multivariable logistic regression model, African American
ethnicity was independently associated with a decreased likelihood of return.
Conclusions: Ethnic disparities in hospice utilization may extend even to those patients who
do enroll in hospice. African Americans who leave hospice during their first admission and
their families may be less likely to have access to the comprehensive services that hospice
programs provide near the end of life, including intensive nursing care, pain and symptom
management, and education.
