Table 2.
Multilevel Models of Hospice Use by NH Decedents, With and Without Interactions
| AOR (95% CI) |
||
| Independent variables | Model 1 | Model 2 (Model 1 + interaction terms) |
| Decedent attributes | ||
| Race: Black | 0.97 (0.94-1.01) | 0.81 (0.77-0.86) |
| Sex: women | 1.22 (1.20-1.24) | 1.23 (1.20-1.25) |
| Age at death: <75 years | Ref | Ref |
| Age at death: >75-80 years | 0.97 (0.94-1.00) | 0.97 (0.93-1.01) |
| Age at death: >80-85 years | 0.94 (0.91-0.97) | 0.94 (0.90-0.97) |
| Age at death: >85-90 years | 0.92 (0.89-0.95) | 0.92 (0.89-0.95) |
| Age at death: >90 years | 0.87 (0.84-0.90) | 0.87 (0.84-0.90) |
| Married | Ref | Ref |
| Widowed | 0.96 (0.94-0.98) | 0.97 (0.95-0.99) |
| Single | 0.91 (0.88-0.94) | 0.90 (0.88-0.92) |
| <High school | 1.00 (0.98-1.02) | 1.00 (0.98-1.02) |
| High school | Ref | Ref |
| Some college+ | 1.01 (0.99-1.03) | 1.01 (0.99-1.03) |
| Power attorney | 1.12 (1.09-1.15) | 1.12 (1.10-1.14) |
| DNR | 1.83 (1.79-1.87) | 1.77 (1.73-1.81) |
| DNH | 1.47 (1.42-1.52) | 1.45 (1.35-1.43) |
| Living will | 1.26 (1.23-1.29) | 1.45 (1.41-1.50) |
| Cancer | 2.51 (2.42-2.59) | 2.47 (2.39-2.55) |
| Alz. | 1.25 (1.21-1.29) | 1.25 (1.19-1.25) |
| Non-Alz. dementia | 1.25 (1.22-1.28) | 1.25 (1.22-1.28) |
| CHF | 0.86 (0.84-0.88) | 0.87 (0.85-0.89) |
| Stroke | 0.96 (0.94-0.98) | 0.96 (0.95-0.99) |
| Long stay (>90 days) | 2.16 (2.11-2.20) | 2.16 (2.12-2.20) |
| NH attributes | ||
| For-profit | 0.94 (0.90-0.98) | 0.94 (0.90-0.98) |
| Low tier | 1.01 (0.92-1.10) | 0.96 (0.87-1.06) |
| Chain-affiliated | 1.07 (1.03-1.10) | 1.07 (1.03-1.10) |
| High deficiencies | 1.02 (0.98-1.04) | 1.01 (0.98-1.03) |
| County attributes | ||
| Bottom quartile of hospices | Ref | Ref |
| Second quartile of hospices | 1.39 (1.26-1.54) | 1.39 (1.26-1.54) |
| Third quartile of hospices | 1.58 (1.39-1.80) | 1.58 (1.39-1.80) |
| Top quartile of hospices | 1.73 (1.48-2.03) | 1.73 (1.48-2.03) |
| Low MDsa | 0.89 (0.80-0.99) | 0.89 (0.80-0.99) |
| Middle MDsa | Ref | Ref |
| High MDsa | 1.04 (0.93-1.17) | 1.04 (0.93-1.17) |
| Low hospital bedsa | 1.17 (1.02-1.25) | 1.13 (1.02-1.25) |
| Middle hospital bedsa | Ref | Ref |
| High hospital bedsa | 1.02 (0.91-1.15) | 1.04 (0.91-1.15) |
| Low NH bedsa | 0.98 (0.88-1.10) | 0.98 (0.88-1.10) |
| Middle NH bedsa | Ref | Ref |
| High NH bedsa | 1.00 (0.90-1.11) | 0.99 (0.90-1.11) |
| Low % occupied NH bedsa | 1.18 (1.05-1.32) | 1.18 (1.05-1.32) |
| Middle % occupied NH bedsa | Ref | Ref |
| High % occupied NH bedsa | 1.03 (0.93-1.13) | 1.03 (0.93-1.13) |
| Interaction terms | ||
| Black and single | n/a | 1.10 (1.01-1.17) |
| Black with cancer | n/a | 1.16 (1.04-1.29) |
| Black with CHF | n/a | 0.90 (0.84-0.97) |
| Black with DNR | n/a | 1.33 (1.25-1.42) |
| Black with DNH | n/a | 1.17 (1.02-1.33) |
| Black in low-tier NH | n/a | 1.20 (1.03-1.39) |
| Model validation results | ||
| Model 1 | Model 2 | |
| NH variance | 0.4677 | 0.4674 |
| NH-level correlation | 14.54% | 14.55% |
| County variance | 0.1781 | 0.1786 |
| County-level correlation | 4.58% | 4.02% |
| Log likelihood | -16,7028.41 | -16,6968.37 |
| AIC | 334228.8 | 334120.7 |
| Wald χ2 | 16,670.09 (83) | 16,768.13 (89) |
Note: AOR = adjusted odds ratio; NH = nursing home; CI = confidence interval; DNR = do not resuscitate; DNH = do not hospitalize; Alz. = Alzheimer's disease; CHF = congestive heart failure; MD = medical doctor; AIC = Akaike's Information Criterion; n/a = not applicable.
a
Per 100 aged >65 years.