SHM Converge Scientific Abstract ePoster Gallery-An Intervention to Improve Advance Care Planning Documentation Unmasks Disparities

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Researchers at UCSF studied whether an intervention to improve advance care planning (ACP) documentation for hospitalized medicine patients also affected racial and ethnic disparities. ACP is important for older adults and patients with serious illness, but minority patients are often less likely to have documented advance directives or living wills.<br /><br />The intervention was rolled out across the Hospital Medicine Service between February 2019 and December 2020. It focused on making ACP documentation easier to access and more visible in the electronic medical record for patients older than 75 or those with serious illness. The team used an interrupted time series analysis to compare ACP documentation before and after the intervention.<br /><br />Overall, documentation improved significantly after the intervention, with a 50% increase and a 2.47% monthly rise above baseline. There were no significant language-based differences in improvement.<br /><br />However, the benefits were not equal across racial and ethnic groups. ACP documentation increased faster for non-Hispanic White patients than for Hispanic/Latino patients and African American/Black patients. Specifically, the monthly increase was 2.72% for non-Hispanic White patients versus 1.84% for Hispanic/Latino patients and 1.9% for African American/Black patients.<br /><br />The authors concluded that while the intervention improved ACP documentation overall, it widened existing disparities for Hispanic/Latino and Black patients. They propose a conceptual framework to explain this and to guide future interventions. The key takeaway is that quality improvement efforts should be evaluated across race and ethnicity to ensure they do not unintentionally worsen health disparities.

Asset Subtitle

Priyanka v. Athavale

Meta Tag

Author List Michelle S. Mourad, Molly A. Kantor, Priyanka v. Athavale, Sandra Oreper, Sarah Flynn

Category Research

Concept Advance care planning

Concept Medical Decision-Making

Concept Racial Disparity

Concept Ethnic Disparity

Concept Advance Directive

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author Priyanka v. Athavale

Track Quality Improvement

Keywords

advance care planning

ACP documentation

health disparities

racial and ethnic disparities

hospitalized patients

electronic medical record

interrupted time series

older adults

serious illness

quality improvement

Advance care planning

Medical Decision-Making

Racial Disparity

Ethnic Disparity

Advance Directive