The Impact of Race on Advanced Care Planning: Results of a Quality Improvement Project

Research suggests racial disparities affect the likelihood that patients engage in advanced care planning (ACP). With this quality assurance initiative, we sought to determine whether racial disparities exist in ACP at our institution.

We performed a retrospective chart review of patients 65 years of age and older who were seen at our institution from January 1, 2021 through December 31, 2022. The primary objective was to determine whether racial disparities exist in ACP among these patients. ACP was identified if the electronic health record (EHR) indicated presence of an advance directive, healthcare power of attorney, and/or ACP discussion or visit with a clinician.

In total, 22,372 patients were included. The median age was 74.1 (interquartile range [IQR] 69.4-80.5). White patients accounted for 87.4% of the total, 11.2% were Black, and 1.4% were another race. Females were 51.5%, 55.1% were married, and 88 % were insured by Medicare. Black patients and patients of other races were less likely than White patients to have an ACP (adjusted odds ratio [aOR] = 0.64; 95% confidence interval [CI], 0.58-0.71; P < .0001 and aOR = 0.63; 95% CI, 0.48-0.82; P = .0007, respectively). Older patients and those with more chronic disease (elevated Charlson comorbidity index) were more likely to complete ACP (aOR = 1.48; 95% CI, 1.42-1.54; P < .0001 and aOR = 1.32; 95% CI, 1.30-1.35; P < .0001, respectively).

Our findings show differences in rates of ACP completion by race at our institution, which is consistent with previous research. The next step in our quality initiative is to develop interventions to promote equitable opportunities for such planning.