Evidence map›Paper›PMID 35974437›Full record

ArticleThe Permanente journal2022

Advance Directive Completion Among Black Adults Within a Community-Based Integrated Health Care System.

Jessica Himmelstein, Liisa Lyon, Chelsea Gong, Carol Conell, Nirmala Ramalingam, Karina Chavez, Loveleena Virk, Ruben Gonzalez

Open access · greenAbstract read
In one paragraph

Article in The Permanente journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact, top 85% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Jessica HimmelsteinDepartment of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Liisa LyonDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Chelsea GongDepartment of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Carol ConellDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Nirmala RamalingamGraduate Medical Education, Kaiser Oakland Medical Center, Oakland, CA, USA.
Karina ChavezDepartment of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Loveleena VirkDepartment of Hospital Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Ruben GonzalezDepartment of Family Medicine, Kaiser Permanente Vallejo Medical Center, Vallejo, CA, USA.
Kaiser Permanente Oakland Medical Center · USKaiser Permanente · USKaiser Permanente Vallejo Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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.

Indexed as

Advance Care PlanningDelivery of Health Care, IntegratedAdultAdvance DirectivesBlack or African AmericanHumansMiddle AgedRetrospective Studiesaccess to careadvance care planningadvance directivesAfrican Americanshealthcare disparities

Identifiers

PMID35974437
PMCPMC9683738
OpenAlexW4292291707

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.