Advance Care Planning, Race, and Age

There are well-documented racial disparities in the provision of end-of-life care and advance care planning (ACP). It is unclear whether these observed disparities are explained by other variables. This analysis sought to determine whether any apparent racial disparities among general medicine inpatients in the provision of ACP services persisted after adjustment for potential confounders. The authors conducted a secondary analysis of electronic health records data collected as baseline data for a quality improvement program. The analysis included all patients who were discharged by hospitalists at an academic medical center from 4 general medicine inpatient units from July 2022 to June 2023, and who were identified as having limited life expectancy. The independent variables were demographic and clinical characteristics. The dependent variable was a composite of 4 ACP process measures (palliative care consultation, hospice discharge, comfort care status, or ACP note). Poisson regression was used to determine the association between patient characteristics and any ACP service. The analysis included 580 hospitalizations for 552 eligible patients. Patients had an average age of 73.8 years (SD 17.1), 54.5% were female, 51.3% were non-Hispanic White, 74.6% had Medicare, 43.8% had cancer, 20.5% had dementia, and 7.8% had heart failure. In unadjusted analyses, non-Hispanic Black patients were less likely to receive ACP services. However, when adjusted for age, sex, insurance, and medical conditions, the apparent racial disparity did not persist. To accurately assess health disparities in the context of quality improvement, adjustment for potential confounders may be needed.