Hospice utilization of Medicare beneficiaries in Hawai‘i compared to other states

The objective is to examine hospice utilization among Medicare beneficiaries in Hawai‘i compared to other states. Data were from the 2014 Medicare Hospice Utilization and Payment Public Use File, which included information on 4,025 hospice providers, more than 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments. Multivariable linear regression models were estimated to compare hospice utilization in Hawai‘i to that of other states. Control variables included age, gender, and type of Medicare coverage. Medicare beneficiaries using hospice in Hawai‘i differed significantly from beneficiaries in other states in several ways. Hawai‘i beneficiaries were more likely to be Asian (57% vs. 1%, p \u3c .001) and “other race” (10% vs. 0.1%, p \u3c .001), and less likely to be White (28% vs. 84%, p \u3c .001). Hawai‘i beneficiaries were also more likely to have Medicare Advantage (55% vs. 30%, p = .05). Regarding primary diagnoses, hospice users in Hawai‘i were significantly more likely to have a primary diagnosis of stroke (11% vs. 8%, p = .03) and less likely to have respiratory disease (5% vs. 11%, p = .003). In addition, hospice users in Hawai‘i were more likely to use services in their homes (74% vs. 52%, p = .03). Hawai‘i hospice users were also less likely to die while in hospice (42% vs. 47%, p = .002). Characteristics of Medicare beneficiaries in Hawai‘i differ from those in other states, regarding demographic characteristics, type of coverage, primary diagnoses, likelihood of using services in their homes, and death rates. Further research is needed to better understand factors affecting these differences and whether these differences warrant changes in policy or practice

Mālama nā makua i nā keiki me ka hānō: Native Hawaiian parents caring for their children with asthma

Native Hawaiian children have the highest prevalence rate of asthma among all ethnicities in the State of Hawai‘i. Literature is limited regarding native Hawaiian parents’ perception and experience caring for their children with asthma. The purpose of this study is to explore contemporary native Hawaiian parents’ perspective and experience of caring for their children with asthma in the context of uncertainty. We applied a descriptive qualitative approach by means of directed content analysis using focus groups. Directed content analysis applied Mishel’s Uncertainty in Illness Theory to guide data collection, organization, and analysis. We found that parents’ personal stories about their children to be rich and enlightening. Findings verified that native Hawaiian parents experience uncertainty regarding asthma care as commonly described in the literature. Contextual influences including indigenous worldview and cultural values affected native Hawaiian parents’ perceptions and experiences with conventional asthma care. Unique findings involved the etiology of asthma, features of social support (‘ohana), and differentiation between Western medicine and traditional healing practices. As nurses focus on supporting the family’s cultural values and preferences related to asthma care and alternative remedies, native Hawaiian parents’ care of their children with asthma will be strengthened

The lived experience of Pacific Island women with a “big body” size

This phenomenological study explored the lived experience with big body size of Pacific Island women who migrated to Hawaii. Giorgi’s descriptive phenomenological approach was utilized in this study. A purposive sample included six Pacific Island women. Five of the six women had migrated to Hawaii from the island nations of Micronesia. The sixth participant was a Native Hawaiian who had lived in Micronesia and had returned to Hawaii. The collection and transcription of data were done by the first author. Data were categorized into themes independently by the three authors and bracketing was maintained throughout the study. The women identified the dichotomy of big body versus small body and the connotation of each body size in how they viewed the world around them. They shared their lifestyle and transitional changes in trying to adapt and ‘fit’ into the new lifestyle in Hawaii. These changes impacted their eating habits and work schedule, level of activity, and financial security. The women identified biopsychosocial concerns in their lives and the need to re-evaluate their big body size in relation to their health and physical and psychosocial changes. Implications for future research are to include a diverse representation of women from island countries within the Pacific Basin. The results of this study provided valuable information related to cultural relevance and sensitivity in working with Pacific Island women in managing their health

Relationship of Associated Cardiovascular Risk Factors and Chronic Kidney Disease with Participants Enrolled in the National Kidney Foundation of Hawai\u27i Kidney Early Detection Screening (KEDS) Program

Objective The objective of this study was to further examine the relationship of associated cardiovascular risk factors and chronic kidney disease (CKD) with a large cross-sectional sample of Native Hawaiians, Japanese, Chinese, Filipino, and White participants who were enrolled in the National Kidney Foundation of Hawai\u27i Kidney Early Detection Screening (KEDS) program. Methods Data for this cross-sectional study was collected between 2006 and 2009 from the National Kidney Foundation of Hawaii (NKFH). Nine hundred and fifteen participants who attended the NKFH KEDS program were 18 years and older, and residents of the State of Hawaii. Data included demographic information, clinical risk factors, anthropometric measurements, and lab values. Microalbuminuria was used as an indicator for CKD. Descriptive analysis using frequencies, means, and standard deviations, chi-square tests, and ANOVA were conducted to examine the differences in cardiovascular disease (CVD) risk factors and normal and abnormal microalbuminuria groups. A multivariate hierarchical logistic regression model was used to identify the CV risk factors associated with abnormal microalbuminuria. The Hosmer and Lemeshow Goodness of Fit test and R-2-type indices examined the fit of the regression model to the data. Results Significant results related to microalbuminuria included BMI (p=0.004), glucose (p=.004), and Japanese ethnicity (p=.008). Conclusion The findings support the need to address CVD risk factors in NKFH KEDS program. Keywords: chronic kidney disease, CVD risk factors, microalbuminuria, Asians, Native Hawaiians Pacific Islander

Discrimination, Racism, Social Inequality, and Injustice Experienced Among Native Hawaiians through the Lens of Historical Trauma

The purpose of this study was to explore the lived experiences of colonization and historical trauma and links to alcohol among Native Hawaiians living in rural Hawaii. Native American groups including, American Indians, and Alaska Natives have experienced historically traumatic events over the past 500 years, after contact with Europeans. Some Indigenous scholars have posited that historical trauma is a primary cause of the current social pathology and health disparities in Native Hawaiians. A phenomenological design was selected for this study using Indigenous storytelling methodology. Two themes emerged including: a) the participants described experiences of negative stereotyping that leads to perceived discrimination and racism which is a trigger for increased thoughts of historical losses including the loss of identity: b) the participants described experiences of social inequality and injustices which has increased the use of alcohol and methamphetamine as a way to cope by self-medicating There remains the need for investigators to examine whether the type of experiences of discrimination, racism, social inequality, and injustice differ for people of various racial-ethnic backgrounds, especially Indigenous people. It is necessary for researchers to examine the impact of these experiences to clarify the prevalence and effects on health and health behaviors

Asian Americans & chronic kidney disease in a nationally representative cohort

BackgroundThere is a paucity of specific data on early stages of chronic kidney disease (CKD) among Asian Americans (AAs). The objective of this study was to examine the independent association of Asian race/ethnicity and socio-demographic and co-morbidity factors with markers of early kidney damage, ascertained by ACR levels, as well as kidney dysfunction, ascertained by eGFR levels in a large cross-sectional sample of AAs enrolled in the National Health and Nutrition Examination Survey (NHANES).MethodsSecondary data analyses of the NHANES 2011-2014 data of a nationally representative sample of 5907 participants 18 years and older, US citizens, and of Asian and White race. NHANES data included race (Asian vs. White), as well as other socio-demographic information and comorbidities. Urine albumin-to-creatinine ratio (ACR) categories and estimated glomerular filtration rate (eGFR) were used as indicators for CKD. Descriptive analyses using frequencies, means (standard deviations), and chi-square tests was first conducted, then multivariable logistic regression serial adjustment models were used to examine the associations between race/ethnicity, other socio-demographic factors (age, sex, education), and co-morbidities (obesity, diabetes, hypertension) with elevated ACR levels (A2 & A3 - CKD Stages 3 and 4-5, respectively) as well as reduced eGFR (G3a-G5 and G3b -G5 - CKD Stage 3-5).ResultsAAs were more likely than White participants to have ACR levels > 300 mg/g (A3) (adjusted OR (aOR) (95% CI) 2.77 (1.55, 4.97), p = 0.001). In contrast, adjusted analyses demonstrated that AAs were less likely to have eGFR levels < 60 ml/min/1.73 m2 (G3a-G5) (aOR (95% CI) 0.50 (0.35, 0.72), p < .001).ConclusionsThis is one of the first large U.S. population-based studies of AAs that has shown a comparatively higher risk of elevated ACR > 300 mg/g levels (A3) but lower risk of having eGFR levels < 60 ml/min/1.732 m2 (G3a-G5). The findings support the need to address the gaps in knowledge regarding disparities in risk of early stage CKD among AAs