Advance Care Planning, Race, and Age

Area of Science:

• Health Services Research
• Health Disparities
• Medical Informatics

Background:

• Racial disparities in end-of-life care and advance care planning (ACP) are documented.
• It remains unclear if these disparities are explained by other variables.

Purpose of the Study:

• To determine if racial disparities in ACP services among general medicine inpatients persist after adjusting for potential confounders.
• Investigating the impact of demographic and clinical factors on ACP provision.

Main Methods:

• Secondary analysis of electronic health records from an academic medical center.
• Included general medicine inpatients with limited life expectancy discharged between July 2022 and June 2023.
• Used Poisson regression to analyze the association between patient characteristics and ACP services (palliative care consultation, hospice discharge, comfort care, or ACP note).

Main Results:

• Analysis included 580 hospitalizations for 552 patients (average age 73.8 years, 51.3% non-Hispanic White).
• Unadjusted analyses showed non-Hispanic Black patients were less likely to receive ACP services.
• Adjusting for age, sex, insurance, and medical conditions eliminated the apparent racial disparity.

Conclusions:

• Apparent racial disparities in ACP services among general medicine inpatients did not persist after adjustment for confounders.
• Accurate assessment of health disparities in quality improvement requires adjustment for potential confounding variables.
• Further research should explore the nuanced factors influencing ACP provision across diverse patient populations.