Abstract Details

Neurological disease remains a leading cause of disability-adjusted life-years. On average, only 37% of Americans have advanced directives for end-of-life care and 33% have appointed a health care power of attorney. Racial/ethnic minorities are less likely to discuss goals of care with their provider or appoint a health care power of attorney. Patients admitted to Boston Medical Center (BMC) inpatient neurology service with devastating illnesses are often unable to appoint an HCP leading to prolonged hospitalizations and delays in discharge to rehabilitation. By identifying barriers and disparities in outpatient clinic HCP form completion, targeted intervention may be implemented.

To examine racial/language disparities in appointing a Health Care Proxy (HCP) in an urban outpatient neurology clinic.

Neurology clinic data from December 2019 was reviewed. Demographic information (including HCP status) and clinic subtype were recorded from 1461 patients. A Pearson chi-square test was performed to evaluate differences in HCP completion status, particularly among different language, race, and ethnicity groups.

Only 17.9% of BMC neurology clinic patients had appointed HCPs. English-speakers had a significantly higher proportion (21.5%) than non-English-speakers (11.8%, p-value <0.0001). There was a significant difference among all races (p-value <0.0001), with Black patients having significantly higher completion rates (26.4%) than White (18.8%, p-value = 0.006), Hispanic (14.3%, p-value = 0.014), Asian (10.4%, p-value = 0.015), and patients who declined to disclose race (9.3%, p-value <0.0001). Non-Hispanics (20.7%) had a significantly higher HCP-proportion compared to those who identified as Hispanic/Latino (12.0%, p-value = 0.0002).

There were significant disparities in HCP status among language, race, and ethnic groups. Future goals aim to create a culturally-sensitive system that provides HCP forms to clinic patients in the patient’s spoken language upon check-in with an ultimate aim of reducing the number of patients admitted to the inpatient service with guardianship as a barrier to discharge.