# Racial/Ethnic Differences in Palliative Care Services and Potentially Avoidable Hospitalizations at End-of-Life in Nursing Homes Nationwide

> **NIH NIH F31** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2022 · $5,125

## Abstract

On any day, approximately 1.6 million Americans live in the nation’s nursing homes (NHs) and 90% of the
residents are ≥ 65 years old. In the last two decades, there has been an increase in the proportion of
racial/ethnic minority NH residents and a decrease in non-Latino White NH residents. Racial/ethnic minorities
often reside in NHs situated in low-income communities that are poorly resourced and provide low quality of
care. COVID-19 has highlighted the increased vulnerability of racial/ethnic minority NH residents. Prior to
COVID-19, an estimated 25% of all deaths in the US occurred in NHs and approximately 44% of non-hospice
NH residents experienced hospitalizations during the last 30 days of life. Racial/ethnic minority NH residents
experience increased hospitalizations compared to non-Latino White NH residents. Many of these
hospitalizations are potentially avoidable. Palliative care is essential in providing high quality end-of-life care by
alleviating symptoms and providing support to patients and caregivers; yet, palliative care is suboptimal in
many NHs. In preliminary work using 2017 data from the randomly sampled, national, stratified survey (n =
892) from the Study of Infection Management and Palliative Care at the End-of-Life (SIMP-EL; R01 NR013687;
Stone PI and mentor), I found wide variation in NH palliative care services at the end-of-life. However, health
disparities in NH palliative care services has not been studied. Furthermore, it is unknown how variations in NH
palliative care services are associated with potentially avoidable hospitalizations at the end-of-life. Guided by
the Gelberg-Andersen’s Behavioral Model for Vulnerable Populations, in the proposed study I will address
these gaps by conducting a secondary, cross-sectional analysis using multiple data sources (i.e., the SIMP-EL
survey; NH resident assessments from the Minimum Data Set 3.0; hospital claims data from the Medicare
Provider and Analysis Review; NH facility characteristics from the Certification and Survey Provider Enhanced
Reporting; and county level data from the Area Health Resources Files). Specifically, my aims are to: 1)
Describe palliative care services provided in NHs across the nation and identify differences by population
served (i.e., proportion of racial/ethnic minorities) and 2) Identify associations between palliative care services
and potentially avoidable hospitalizations at the end-of-life by NH resident’s race/ethnicity. Aim 1 is a NH level
analysis and Aim 2 is an individual resident level analysis. This research aligns with the National Institute of
Nursing Research priority area of End-of-Life and Palliative Care Research to improve palliative care strategies
for individuals and families with serious illness. To facilitate this research, the applicant will build her knowledge
and skills in palliative care, quantitative research methods, and racial/ethnic health disparities. As a Latina pre-
doctoral student with the dedicated mentorshi...

## Key facts

- **NIH application ID:** 10418632
- **Project number:** 5F31NR019519-02
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Leah V Estrada
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $5,125
- **Award type:** 5
- **Project period:** 2021-07-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10418632

## Citation

> US National Institutes of Health, RePORTER application 10418632, Racial/Ethnic Differences in Palliative Care Services and Potentially Avoidable Hospitalizations at End-of-Life in Nursing Homes Nationwide (5F31NR019519-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10418632. Licensed CC0.

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