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Advance Directive Completion Among Black Adults Within a Community-Based Integrated Health Care System.

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|August 17, 2022
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Black adults were half as likely to complete advance directives (AD) compared to White adults, even with access to care planning specialists. This disparity in AD completion and healthcare utilization persists.

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African Americansaccess to careadvance care planningadvance directiveshealthcare disparities

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Area of Science:

  • Health Services Research
  • Health Disparities
  • Geriatric Medicine

Background:

  • Advance directive (AD) completion is crucial for patient-centered care, particularly for older adults.
  • Integrated health systems offer opportunities to study disparities in advance care planning (ACP).
  • Understanding factors influencing AD completion among diverse populations is essential.

Purpose of the Study:

  • To compare AD completion rates between Black and non-Hispanic White adults within an integrated health system.
  • To identify differences in medical service utilization and sociodemographic factors impacting ACP engagement.
  • To assess the influence of access to outpatient ACP specialists on AD completion.

Main Methods:

  • Retrospective analysis of electronic health records for 572,466 Kaiser Permanente Northern California members (≥55 years) from 2013-2017.
  • Comparison of AD completion rates between Black adults (11.7%) and non-Hispanic White adults (20.3%).
  • Analysis of demographic data, comorbidities (Charlson comorbidity score ≥ 3), and healthcare utilization (inpatient, outpatient, ED visits).

Main Results:

  • Black adults were younger but had higher comorbidity burden and more ED visits than White adults.
  • The crude AD completion rate was significantly lower for Black adults (10.0%) vs. White adults (20.3%).
  • Adjusted analysis showed Black adults were half as likely to complete ADs (11.7% vs. 20.3%) and less likely to use outpatient services.

Conclusions:

  • Black adults in this integrated health system were significantly less likely to complete advance directives, despite access to ACP specialists.
  • Healthcare utilization patterns, including higher ED use and lower outpatient service use, were observed among Black adults.
  • Disparities in AD completion and service utilization highlight the need for targeted interventions to improve ACP engagement in minority populations.