Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Perm J. 2022 Sep 14;26(3):69-73. doi: 10.7812/TPP/21.190. Epub 2022 Aug 16.
ObjectivesThe study was conducted to estimate the prevalence of advance directive (AD) completion among Black adults vs non-Hispanic White adults within Kaiser Permanente Northern California integrated health system that includes access to outpatient advance care planning (ACP) specialists and to identify medical services utilization patterns and societal factors that could influence ACP engagement. DesignThe study was carried out through retrospective analysis of electronic health record data of active Kaiser Permanente Northern California members from January 1, 2013 to December 31, 2017, who were age 55 and older, and represented 572,466 active members, of which 11.7% were Black adults. The primary objective was AD completion comparing Black adults to non-Hispanic White adults. Demographic data included age, sex, comorbidities (Charlson comorbidity score ≥ 3) and medical services utilization (inpatient, outpatient, and emergency department [ED] use). Sociodemographic data derived from census data that include census block demographics and head of household educational attainment were utilized. ResultsBlack adults were younger, but had a higher burden of comorbidities (Charlson comorbidity score ≥ 3, 25.3% vs 19.3%) and were more likely to have multiple ED visits (6.7% vs 3.3%) compared to non-Hispanic White adults. The crude AD completion rate was lower among Black adults (10.0% vs 20.3%), and after adjusting for age and health system service area, the difference remained largely unchanged (11.7% vs 20.3%) compared to non-Hispanic White adults. ConclusionsAmong Kaiser Permanente Northern California members with access to outpatient ACP specialists, Black adults were only half as likely to complete an AD. This disparity was only slightly attenuated when standardized for age and health system service area. In addition, Black adults were also less likely to use outpatient services and more likely to use ED services.
本研究旨在估计 Kaiser Permanente 北加州综合医疗系统中，黑人群体与非西班牙裔白人群体完成预立医疗指示（AD）的比例，该系统提供门诊预立医疗照护计划（ACP）专家服务，并确定可能影响 ACP 参与的医疗服务利用模式和社会因素。
本研究通过回顾性分析 2013 年 1 月 1 日至 2017 年 12 月 31 日期间 Kaiser Permanente 北加州活跃成员的电子健康记录数据进行，纳入年龄在 55 岁及以上、代表 572466 名活跃成员的患者，其中 11.7%为黑人群体。主要目标是比较黑人群体与非西班牙裔白人群体完成 AD 的情况。人口统计学数据包括年龄、性别、合并症（Charlson 合并症评分≥3）和医疗服务利用（住院、门诊和急诊就诊）。社会人口统计学数据来源于人口普查数据，包括普查块人口统计数据和户主受教育程度。
黑人群体比非西班牙裔白人群体更年轻，但合并症负担更重（Charlson 合并症评分≥3，25.3% vs. 19.3%），且更有可能多次急诊就诊（6.7% vs. 3.3%）。黑人群体的 AD 完成率较低（10.0% vs. 20.3%），在调整年龄和医疗系统服务区域后，差异基本保持不变（11.7% vs. 20.3%），而非西班牙裔白人群体。
在有门诊 ACP 专家服务的 Kaiser Permanente 北加州成员中，黑人群体完成 AD 的可能性仅为非西班牙裔白人群体的一半。当按年龄和医疗系统服务区域标准化后，这种差异略有减轻。此外，黑人群体也较少使用门诊服务，更有可能使用急诊服务。
