2024 Theses Doctoral

Health Disparities in Timely Goals of Care Discussions and Hospitalizations Due to Infections in Nursing Home Residents

Kang, Jung A.

This dissertation investigates the effectiveness of and disparities in timely goals of care (TGOC) discussions in nursing homes (NHs), as well as hospitalizations due to infections.

Chapter One provided an overview of the dissertation, including its aims and conceptual frameworks. Chapter Two is a systematic review of the current evidence concerning the timing of goals of care discussions in NHs and their impact on end-of-life outcomes. Chapter Three examines the differences in TGOC discussions in NHs for Black. Chapter Four analyzes the association between TGOC discussions and hospitalizations due to infections.

Finally, Chapter Five synthesizes all findings. Key findings demonstrate that while effective TGOC discussions are associated with reduced hospitalizations due to infections in NH residents, significant racial and ethnic disparities exist, particularly among NHs with higher proportions of Black residents and those located in socioeconomically disadvantaged areas. These findings highlight the need for improved TGOC practices and targeted interventions to address systemic barriers and ensure equitable end-of-life care.