Researchers at Mount Sinai School of Medicine have found that 98 percent of the U.S. population lives in communities within 60 minutes of a hospice provider, suggesting that disparities in use of hospice are not likely due to a lack of access to a hospice provider. The results are published in the current issue of the Journal of Palliative Medicine.
"Despite a significant increase in the availability of hospice services during the past decade, the majority of Americans die without hospice care," said Melissa D.A. Carlson, PhD, Assistant Professor of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine. "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."
Studies have shown that enrollment in hospice helps address end-of-life concerns facing patients and their caregivers. Hospice services offer symptom management, medication delivery, home crisis intervention, and psychosocial support during one of the most difficult and emotionally demanding phases of the patient's illness.
Dr. Carlson's research team studied data from the 2008 Medicare Provider of Services data, U.S. Census data, and geographic mapping software. Census tract characteristics evaluated included population per mile, population over the age of 65, median household per capita income, percentage over the age of 18 with less than a high school education, black population percentage, and census region. The team determined that 98 percent of the U.S. population lives within 60 minutes of a hospice, and 88 percent live within 30 minutes from one.
The average number of minutes between a community center and a hospice was 15 minutes. The number of minutes to the nearest hospice was lower in communities with several characteristics, including: higher population per square mile, higher median household income, lower percentage with less than a high school education, and a higher black population percentage. Communities with higher percentages of the population who are black are more likely to have geographic access to hospice, but previous research has shown that people who are black are less likely to use hospice compared with people who are white.
"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."
Co-authors on the study were R. Sean Morrison, MD, Professor, Geriatrics and Palliative Medicine, and Ms. Qingling Du, Senior Research Analyst, both of Mount Sinai School of Medicine and Elizabeth H. Bradley, PhD, Professor of Public Health at Yale University.
About The Mount Sinai Medical Center
The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of few medical schools embedded in a hospital in the United States. It has more than 3,400 faculty in 32 departments and 15 institutes, and ranks among the top 20 medical schools both in National Institute of Health funding and by U.S. News & World Report. The school received the 2009 Spencer Foreman Award for Outstanding Community Service from the Association of American Medical Colleges.
The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation's oldest, largest and most-respected voluntary hospitals. U.S. News & World Report consistently ranks The Mount Sinai Hospital among the nation's best hospitals based on reputation, patient safety, and other patient-care factors. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 530,000 outpatient visits took place.
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