Geographic Disparities in Hospice Quality and Family Caregiver Experience: The Roles of Ownership, Social Vulnerability, and Workforce Capacity
Abstract
Hospice quality should be interpreted in relation to both provider organization and the local conditions under which care is delivered. This study develops a provider-county performance assessment framework by linking national Centers for Medicare & Medicaid Services (CMS) hospice data and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey outcomes with county measures of rurality, social vulnerability, health burden, and workforce and health-resource context. The adjusted analysis includes 2,928 providers in 1,078 counties and combines geographic mapping, blockwise regression, six secondary CAHPS outcomes, and eight sensitivity analyses. Adding county context increased adjusted R-squared from 0.077 to 0.202. After full adjustment, for-profit hospices had overall caregiver ratings 3.832 percentage points lower than nonprofit hospices. This negative association appeared across all six secondary CAHPS domains and remained significant in every sensitivity specification. Higher county social vulnerability was also associated with poorer caregiver experience, although its magnitude depended partly on the specification of community health burden. These findings show that county context materially improves hospice performance assessment but does not eliminate the ownership difference. The framework supports context-aware monitoring, peer comparison, and targeted quality improvement.
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BibTeX
@misc{cha2026geographic,
title = {{Geographic Disparities in Hospice Quality and Family Caregiver Experience: The Roles of Ownership, Social Vulnerability, and Workforce Capacity}},
author = {Jinho Cha and Misun Roh},
howpublished = {arXiv},
year = {2026},
month = sep,
doi = {10.48550/arxiv.2609.36507},
eprint = {2609.36507},
archivePrefix = {arXiv},
url = {https://arxiv.org/abs/2609.36507},
}
RIS
TY - UNPB
TI - Geographic Disparities in Hospice Quality and Family Caregiver Experience: The Roles of Ownership, Social Vulnerability, and Workforce Capacity
AU - Jinho Cha
AU - Misun Roh
PY - 2026
DA - 2026/09/29
PB - arXiv
DO - 10.48550/arxiv.2609.36507
UR - https://arxiv.org/abs/2609.36507
AB - Hospice quality should be interpreted in relation to both provider organization and the local conditions under which care is delivered. This study develops a provider-county performance assessment framework by linking national Centers for Medicare & Medicaid Services (CMS) hospice data and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey outcomes with county measures of rurality, social vulnerability, health burden, and workforce and health-resource context. The adjusted analysis includes 2,928 providers in 1,078 counties and combines geographic mapping, blockwise regression, six secondary CAHPS outcomes, and eight sensitivity analyses. Adding county context increased adjusted R-squared from 0.077 to 0.202. After full adjustment, for-profit hospices had overall caregiver ratings 3.832 percentage points lower than nonprofit hospices. This negative association appeared across all six secondary CAHPS domains and remained significant in every sensitivity specification. Higher county social vulnerability was also associated with poorer caregiver experience, although its magnitude depended partly on the specification of community health burden. These findings show that county context materially improves hospice performance assessment but does not eliminate the ownership difference. The framework supports context-aware monitoring, peer comparison, and targeted quality improvement.
ER -