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Dr. M. Courtney Hughes Addresses Racial Disparities in Hospice Care Rates

Dr. M. Courtney Hughes Addresses Racial Disparities in Hospice Care Rates

For many families, hospice care can provide a safe and restful space to spend time with loved ones in the final days of terminal illness. Health Services PhD alumna Dr. M. Courtney Hughes knows this from her own experience. Hughes reflects, “I spent the last week of my grandmother’s life with her in hospice care. While it was a sad time, we had many great moments that week, which was due in part to the comforting care hospice services provided.” Following this experience, Hughes dedicated herself to investigating this “bright spot in health care,” and conducting research aimed at expanding access to hospice care.

Prior studies have shown that there is a racial/ethnic disparity in hospice utilization rates. Specifically, white patients with terminal illness utilize hospice services about 30% more than their counterparts of color. This inequity is concerning, because hospice care has been shown to improve the patient’s quality of life and the experience for family members. Hospice can also decrease the costs related to curative treatments, as it can be considerably less expensive than more intensive treatment such as emergency department visits, mechanical ventilation, and cancer treatments. Says Hughes, “It is crucial that hospices and policymakers take steps to ensure that all terminally ill patients have access to these benefits.”

To explore these issues further, Hughes teamed up with a health economist from Seattle University, Dr. Erin Vernon (UW PhD Economics ’09), to explore how closing the disparities gap in hospice utilization would impact Medicare spending. Says Hughes, “We believed by quantifying the financial impact, we could better inform policymakers considering legislation focused on access to hospice care.” 

The team found that eliminating the gap in hospice utilization between white and underrepresented groups would save, on average, about $2,105 per Medicare enrollee, resulting in nearly $270 million in annual cost savings. After this initial study, Hughes and colleagues ended up writing an op-ed in The Hill, sharing these findings, and stressing the importance of promoting access to the Medicare hospice benefit. 

The team’s subsequent studies collected data from hospice administrators nationwide, to identify important aspects of hospice inclusion strategies. Key strategies identified including tailoring strategies to the local communities, addressing social determinants of health that extend beyond end-of-life care, and having a diverse and bilingual staff.

“The current social dialogue and strong interest in this topic from administrators indicate that this is an ideal time for hospices to focus on improving inclusion,” Hughes says. “Even relatively simple steps, like forming a diversity committee or reaching out to a local community group, can make a significant difference.” Hughes would like to see future work inform the development of more comprehensive approaches to hospice inclusion, for example, efforts that involve hospices, community health care systems, and governmental agencies.

Hughes’ journey to focusing on these issues in her work grew out of her doctoral studies at UW. Hughes recalls, “While in the PhD program, I worked with Drs. Donald Patrick, Jeff Harris, and Peggy Hannon to study health behavior change and disparities based on sociodemographic factors. Similar research questions surface when examining end-of-life care: Are there groups that do not have access? What could be done to help improve access?”

Hughes and her team are now conducting a mixed methods study examining telehealth in hospice care, and its implications for racial/ethnic and rural health disparities. The work is especially timely during the COVID-19 pandemic, as more patients are receiving care through telehealth.

To learn more about Hughes’ work, check out the following:

Academic articles:

1) Hughes MC, Vernon E, Kowalczyk M, Basco-Rodillas M. US Hospices' approach to racial/ethnic minority inclusion: A qualitative study. BMJ Supportive & Palliative Care. In press.

2) Hughes MC, Vernon E. “We are here to assist all individuals who need hospice services”: 

Hospices’ perspectives on improving access for racial/ethnic minorities. Gerontology and 

Geriatric Medicine. 2020 6:1-7.

3)    Hughes MC, Vernon E. Hospice respond to COVID-19: Promoting sustainable inclusion 

   strategies for racial and ethnic minorities. Journal of Gerontological Social Work. 2020.

4) Hughes MC, Vernon E. Closing the gap in hospice utilization for minority Medicare population. Gerontology and Geriatric Medicine. 2019 Jun:5:1-8.

News articles reporting on this research:

1) Providers strategize to close racial gaps in hospice care. Hospice News. March 12, 2021.

2) Hospice outreach to minorities could save Medicare $270 million. Hospice News. September 27, 2019.


1) Promoting access to Medicare hospice benefit could save taxpayers, benefit underserved communities. The Hill. October 11, 2019.

2) Hughes MC. Like sands through the hourglass. Palliative & Supportive Care. 2021.


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