Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018

Abstract

IMPORTANCEThe elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. OBJECTIVE To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US.

Preoperative Advance Care Planning for Older Adults Undergoing High-Risk Surgery: An Essential but Underutilized Aspect of Clinical Care

“…In the current study, the authors reported that the majority of ACP discussions were held by a minority of surgeons and that different institutions and study sites had vastly different rates of ACP documentation. 1 These results are further supported by findings of large variations between physicians and hospitals in ACP reporting in hospitalized frail older adults. 4 These variations in practices at different institutions suggest that it is possible to improve rates of preoperative ACP discussion.…”

“…Given the consensus that ACP is important in the care of older adults undergoing high-risk surgery, one would assume that preoperative ACP discussion is a standard of practice among surgeons and their aging patients. However, in a secondary analysis of a randomized control trial testing a patient-mediated intervention to improve preoperative communication, Kalbfell et al 1 showed that ACP discussions rarely take place prior to major surgery in older adults. This finding highlights the significant discrepancy between the belief that ACP is important, and the actual rate that it is practiced, in older patients undergoing high-risk surgery.…”

“…For instance, some patients provided limited or incomplete information about their wishes for health care management while others felt it was unnecessary to have ACP discussions unless complications arose. 1 However, the latter example counters the purpose of ACP which is to enable patients to make plans about future health care and not reactive to a medical complication or emergency.…”

“…Disparities of health status, health care, and affordability across race and ethnicity have persisted throughout the past 20 years. 1 There is further evidence to support systemic differences that can contribute to differences in health outcomes. 2 Although changes in health care policy such as the Affordable Care Act have expanded health care coverage, and instituted changes that aims to improve health care quality and reduce disparities, it is clear that factors contributing to disparities in care are structural and perhaps systemic.…”

“…Elevated BP, also known as hypertension, is the most important, modifiable risk factor for cardiovascular disease and mortality. 1 Clinically significant effects and improvements in mortality can be achieved with relatively small reductions in BP levels. Long-established lifestyle modifications that effectively lower BP include weight loss, reduced sodium intake, increased physical activity, and limited alcohol intake.…”