Advisory Committee Chair
Donna K Arnett
Advisory Committee Members
Gerald McGwin Jr
Christine S Ritchie
Stacey S Cofield
H Michael Maetz
Document Type
Dissertation
Date of Award
2008
Abstract
The purpose of this investigation was to describe and compare patterns of hospice use in Alabama and to assess barriers to receiving such care as perceived by hospice providers across the state. We used death certificate and other administrative records from the Alabama Center for Health Statistics to ascertain hospice use during the years 2002 to 2005. Crude rates of hospice use were calculated across individual and area-level characteristics. Prevalence ratios were calculated using modified Poisson regression to evaluate the impact of these factors on hospice use. To assess barriers to hospice care, all hospices in Alabama (N = 193) were mailed a questionnaire, of which 107 responded (response rate = 55.4%). We found that one-quarter (24.5%) of all decedents and half (52.0%) of cancer decedents died while under hospice care. Adjusted analyses among all decedents found that men, younger ages at death, and non-cancer deaths were significantly less likely to use hospice. For cancer decedents, adjusted analyses indicated men, those ages ≤ 34 at death, and those who were never married were significantly less likely to receive hospice care. For all deaths and cancer deaths, poverty was found to significantly modify the effects of race (p < 0.0001) and urbanization level (p < 0.0001) on hospice use. Spatial clustering analyses among cancer decedents identified six significant clusters of low hospice use across the state. All clusters were located within urban areas, with each containing multiple hospices. The majority of providers (72.1%) perceived physicians to be the source of barriers with the greatest impact in their community. More specifically, reiii spondents indicated that lack of knowledge regarding hospice among professional and lay groups constituted the barrier with the most impact. Respondents also cited physician difficulties discussing terminality and physician difficulty prognosticating death as leading barriers in their area. Several providers also reported that the excessive number of hospices in the state and the Medicare reimbursement cap indirectly served as barriers to care. Future studies are needed to further assess how these issues impact the receipt and delivery of hospice care. Additional studies should also attempt to confirm the aforementioned interactions.
Recommended Citation
Jenkins, Todd M., "Hospice use in Alabama: A cross-sectional assessment" (2008). All ETDs from UAB. 6811.
https://digitalcommons.library.uab.edu/etd-collection/6811
