RT Journal Article
SR Electronic
T1 The Impact of Race on Advanced Care Planning: Results of a Quality Improvement Project
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 167742
DO 10.3122/jabfm.2025.250310R1
VO 39
IS 1
A1 Lear, Aaron
A1 Arnold, Michael
A1 Bouhenni, Rachida
A1 Mangira, Caroline
A1 Adelman, Megan
A1 Baldie, Kevin
A1 George, Estee
YR 2026
UL http://www.jabfm.org/content/39/1/167742.abstract
AB Introduction 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.Methods 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.Results 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).Conclusions 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.