Term of Award

Fall 2011

Degree Name

Doctor of Public Health (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Department

Jiann-Ping Hsu College of Public Health

Committee Chair

James Stephens

Committee Member 1

Robert Vogel

Committee Member 2

Gerald Ledlow

Committee Member 3

Richard Ackermann

Abstract

The purpose of this study was to examine differences in treatment level at the end of life according to race and socioeconomic status and the extent a palliative intervention may change the course and cost of care. The study population included patients from the Medical Center of Central Georgia (N=2,920). The data were examined as a secondary analysis retrospectively. Data from the medical record and a unique clinical database were coded into descriptive, predictor, and outcome variables to define the population, and the patient's treatment status before and after the intervention. McNemar's test of symmetry, Chi Square, and Logistic Regression models were used to examine relationships between predictor and outcome variables including race, gender, age, disease, income, and education levels affecting code status, comfort status and discharge to hospice. Costs pre- and post-intervention were also examined using the t-test. Results demonstrated that the palliative intervention had a significant effect on costs and care level. Further, African Americans with lower levels of education were more likely to choose aggressive measures than Caucasians. Findings may improve understanding of the palliative intervention and encourage culturally competent end-of-life education.

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