Using Preanesthesia Clinic Visits to Improve Advance Directives Completion: An Interrupted Time Series Analysis.

Area of Science:

• Health Services Research
• Patient Advocacy
• Medical Ethics

Background:

• Advance directives ensure patient autonomy when incapacitated, but completion rates are suboptimal.
• Disparities in advance directives completion exist, particularly among vulnerable patient groups.
• Standardizing discussions during preanesthesia visits may improve documentation rates.

Purpose of the Study:

• To assess the impact of a standardized advance directives discussion initiative during preanesthesia visits.
• To evaluate changes in advance directives completion rates over time following the initiative.
• To determine if the initiative's association with completion rates varied by race, insurance type, or income.

Main Methods:

• A before-and-after interrupted time series evaluation was conducted from January 2015 to June 2019.
• The intervention involved training staff to facilitate advance directives completion during preanesthesia visits.
• Completion rates were analyzed based on race, insurance, and federal poverty level, using segmented regression.

Main Results:

• Crude advance directives completion rates increased from 29% to 78% post-intervention (OR 18; P < 0.001).
• Racial disparities in completion rates narrowed significantly post-intervention (P = .001).
• The income-based completion gap also narrowed by approximately half (P = .04), while insurance-based gaps showed no significant change.

Conclusions:

• Standardizing advance directives discussions during preanesthesia visits significantly increased completion rates.
• The initiative was particularly effective in improving documentation among vulnerable patient groups.
• This approach helps address disparities and promotes equitable advance care planning.