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Background <p>Racial disparities in end-of-life care have been well documented, yet little is known about how both patient and provider races, as well as their concordance, influence the likelihood of advance care planning (ACP) discussions during hospitalization.</p> Objective <p>To evaluate how patient race, provider race, and patient–provider racial concordance are associated with the occurrence of inpatient ACP conversations.</p> Design <p>Retrospective observational cohort study using hierarchical logistic regression.</p> Participants <p>Seriously ill Medicare beneficiaries hospitalized between 2016 and 2019, managed by a national physician staffing organization (PSO)&#xa0;across 220 hospitals in 35 US states. The final sample included 390,392 hospitalizations and 2808 providers.</p> Main Measures <p>The primary outcome was the occurrence of an ACP conversation, identified using CPT codes 99497 and 99498, assessed from admission through day 10 or discharge. Patient and provider races were categorized as White, Black, Hispanic, or Asian. Models included fixed effects for patient demographics, clinical risk, and hospital characteristics, and random effects for hospital clustering.</p> Key Results <p>Asian providers were more likely and Hispanic providers less likely to engage in ACP discussions. Patient–provider racial concordance modestly increased the likelihood of ACP for Black, White, and Hispanic patients, and several cross-race pairings also showed higher engagement. These effects were modest, varied across racial dyads, and occurred in the context of higher than national average inpatient&#xa0;ACP rates under the PSO’s quality improvement initiative.</p> Conclusions <p>Provider race and patient–provider concordance each influenced the likelihood of inpatient ACP, though effects were modest and context-dependent. Concordance and certain racial pairings were associated with higher engagement, but disparities persisted across groups, highlighting that broader structural and communication barriers continue to shape inequities in end-of-life care.</p> Graphical Abstract <p></p>

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The Impact of Race and Physician–Patient Racial Concordance on the Incidence of Inpatient Advance Care Planning

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年3月19日

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  • Benjamin Carter,
  • Satveer Kaur-Gill,
  • Megan Murphy,
  • A. James O’Malley,
  • Amber E. Barnato

摘要

Background

Racial disparities in end-of-life care have been well documented, yet little is known about how both patient and provider races, as well as their concordance, influence the likelihood of advance care planning (ACP) discussions during hospitalization.

Objective

To evaluate how patient race, provider race, and patient–provider racial concordance are associated with the occurrence of inpatient ACP conversations.

Design

Retrospective observational cohort study using hierarchical logistic regression.

Participants

Seriously ill Medicare beneficiaries hospitalized between 2016 and 2019, managed by a national physician staffing organization (PSO) across 220 hospitals in 35 US states. The final sample included 390,392 hospitalizations and 2808 providers.

Main Measures

The primary outcome was the occurrence of an ACP conversation, identified using CPT codes 99497 and 99498, assessed from admission through day 10 or discharge. Patient and provider races were categorized as White, Black, Hispanic, or Asian. Models included fixed effects for patient demographics, clinical risk, and hospital characteristics, and random effects for hospital clustering.

Key Results

Asian providers were more likely and Hispanic providers less likely to engage in ACP discussions. Patient–provider racial concordance modestly increased the likelihood of ACP for Black, White, and Hispanic patients, and several cross-race pairings also showed higher engagement. These effects were modest, varied across racial dyads, and occurred in the context of higher than national average inpatient ACP rates under the PSO’s quality improvement initiative.

Conclusions

Provider race and patient–provider concordance each influenced the likelihood of inpatient ACP, though effects were modest and context-dependent. Concordance and certain racial pairings were associated with higher engagement, but disparities persisted across groups, highlighting that broader structural and communication barriers continue to shape inequities in end-of-life care.

Graphical Abstract