Lawrence S. Wissow|Amy Belote|Wade Kramer|Amy Compton-Phillips|Robert A. Kritzler|Jonathan P. Weiner
Promoting advance directives among elderly primary care patients
Johns Hopkins University|Johns Hopkins University|Kaiser Foundation Hospital|Johns Hopkins University
objective determine efficient ways promoting advance directives among heterogeneous populations elderly ambulatory patients design oneyear quasiexperimental trial setting five suburban urban health centers one region large managed care organization one additional suburban center served control site participants individuals ages 65 older n2120 continuously enrolled health maintenance visit primary care provider study year intervention physician education oral written physician patient prompts discuss advance directives main results sixtysix 78 patients intervention centers completed new advance directives versus 9 1277 1 comparison center p001 patients 75 older twice likely odds ratio 20 95 confidence limits cl 12 33 65 74 file new advance directive odds twice great 26 95 cl 14 46 centers serving communities median household income state median gender recent hospitalization emergency room visits number chronic conditions related making new directives predominant ethnicity center community africanamerican versus white adjusted factors intervention resulted 20fold increase 95 cl 104 478 odds creating new advance directive doctors reported barriers time unwillingness press discussions patients conclusions replicable intervention largely targeting doctors achieved modest increase advance directives among elderly ambulatory patients future interventions may need target lowerincome patients younger elderly specifically address doctors attitudes comfort discussing advance directives