# Investigating Multi-Level Determinants of Racial/Ethnic Disparities in Quality of End-of-Life Care for Veterans

> **NIH VA I01** · PHILADELPHIA VA MEDICAL CENTER · 2021 · —

## Abstract

Background: Racial/ethnic disparities are well-documented in the VA healthcare system, however, little is
known in the area of end-of-life (EOL) care. Our preliminary work suggests the presence of large and
significant disparities by race/ethnicity in family perceptions of the quality of care received by the Veteran and
family at EOL, despite equal use of hospice and palliative care services. These findings illuminate the need to
identify other care processes as well as organizational features of VA Medical Centers (VAMCs) that may
explain the differences we observe. Racial/ethnic minorities are more likely to prefer life-prolonging, intensive
measures near EOL and may be more likely to experience burdensome transitions as compared to non-
minorities. These care patterns may contribute to overall dissatisfaction with care when rated by patients and
their families; however, the nature of these relationships in VA is not known. A growing body of literature also
suggests that the organization of nursing care- a modifiable characteristic of healthcare facilities - may play a
key role in moderating racial/ethnic disparities, but has not been explored in the context of EOL care.
Specific Aims: The specific aims of this project are to: 1) examine EOL care patterns, including burdensome
transitions and intensive EOL care, comparing racial/ethnic minority to non-minority Veteran populations; and
to describe organizational nursing characteristics of VAMCs where minority and non-minority Veterans are
cared for at the EOL; 2) identify the extent to which observed racial/ethnic differences in family perceptions of
EOL care quality are associated with EOL care patterns and modifiable aspects of nursing care organization,
including nurse staffing, the nurse work environment, and racial/ethnic diversity of nursing staff; and 3) explore
the perspectives of bereaved family members of racial/ethnic minority and non-minority Veterans on factors
that influence quality of EOL care, including EOL care patterns and nursing care.
Significance and Relevance to Veterans' Health: As the Veteran population continues to grow in age and
diversity, greater focus on care at EOL will become imperative. Currently, there is a dearth of evidence to guide
culturally-tailored, Veteran-and family-centered EOL care in VAMCs.
Methodology: We will employ a concurrent triangulation, mixed methods study design using a variety of VA
secondary data sources collected between Fiscal Years (FY) 2011-2015. Major data sources include: the
Clinical Data Warehouse (CDW), the VA Nursing Outcomes Database (VANOD), and the Bereaved Family
Survey (BFS) - a well-validated instrument completed by bereaved family members of Veterans. The sample
will include nearly all inpatient deaths in 142 VA Medical Centers nationally (n=~46,000) during the study
period. BFS responses are available for nearly 60% of these decedents (n=~25,000). Multi-level logistic
regression models will be used to examine the main effe...

## Key facts

- **NIH application ID:** 10186509
- **Project number:** 5I01HX002190-03
- **Recipient organization:** PHILADELPHIA VA MEDICAL CENTER
- **Principal Investigator:** Ann Kutney Lee
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-04-01 → 2021-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10186509

## Citation

> US National Institutes of Health, RePORTER application 10186509, Investigating Multi-Level Determinants of Racial/Ethnic Disparities in Quality of End-of-Life Care for Veterans (5I01HX002190-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10186509. Licensed CC0.

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