Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care
ABSTRACT Understanding whether and why there are racial disparities in readmissions has implications for efforts to reduce readmissions.
To determine whether black patients have higher odds of readmission than white patients and whether these disparities are related to where black patients receive care.
Using national Medicare data, we examined 30-day readmissions after hospitalization for acute myocardial infarction (MI), congestive heart failure (CHF), and pneumonia. We categorized hospitals in the top decile of proportion of black patients as minority-serving. We determined the odds of readmission for black patients compared with white patients at minority-serving vs non-minority-serving hospitals.
Medicare Provider Analysis Review files of more than 3.1 million Medicare fee-for-service recipients who were discharged from US hospitals in 2006-2008.
Risk-adjusted odds of 30-day readmission.
Overall, black patients had higher readmission rates than white patients (24.8% vs 22.6%, odds ratio [OR], 1.13; 95% confidence interval [CI], 1.11-1.14; P < .001); patients from minority-serving hospitals had higher readmission rates than those from non-minority-serving hospitals (25.5% vs 22.0%, OR, 1.23; 95% CI, 1.20-1.27; P < .001). Among patients with acute MI and using white patients from non-minority-serving hospitals as the reference group (readmission rate 20.9%), black patients from minority-serving hospitals had the highest readmission rate (26.4%; OR, 1.35; 95% CI, 1.28-1.42), while white patients from minority-serving hospitals had a 24.6% readmission rate (OR, 1.23; 95% CI, 1.18-1.29) and black patients from non-minority-serving hospitals had a 23.3% readmission rate (OR, 1.20; 95% CI, 1.16-1.23; P < .001 for each); patterns were similar for CHF and pneumonia. The results were unchanged after adjusting for hospital characteristics including markers of caring for poor patients.
Among elderly Medicare recipients, black patients were more likely to be readmitted after hospitalization for 3 common conditions, a gap that was related to both race and to the site where care was received.
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ABSTRACT: High 30-day readmission rates are a major burden to the American medical system. Much attention is on transitional care to decrease financial costs and improve patient outcomes. Social workers may be uniquely qualified to improve care transitions and have not previously been used in this role. We present a case study of an older, dually eligible Latina woman who received a social work-driven transition intervention that included in-home and telephone contacts. The patient was not readmitted during the six-month study period, mitigated her high pain levels, and engaged in social outings once again. These findings suggest the value of a social worker in a transitional care role.Social Work in Health Care 03/2015; 54(3):177-92. DOI:10.1080/00981389.2015.1005273 · 0.62 Impact Factor
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ABSTRACT: Objectives To determine the perspectives of seriously ill individuals on reasons for 30-day hospital readmission.DesignA prospective qualitative study was conducted employing individual interviews conducted at bedside.SettingDepartment of Veterans Affairs Greater Los Angeles Healthcare System.ParticipantsSeriously ill individuals with heart failure or cancer receiving inpatient palliative care and readmitted to the hospital within 30 days of hospital discharge were recruited to participate. Nine were interviewed.MeasurementsA semistructured interview protocol was used to elicit participant perspectives on readmission causes.ResultsAll participants were male and had a mean age of 70.1 ± 9.5. Participants were ethnically diverse (three African Americans, three Caucasians, three Hispanic or mixed ethnic background). Six lived alone, and four did not have caregiver support. Qualitative analysis of transcripts revealed three themes relating to reasons for hospital readmission: lack of caregiver support and motivation to provide self-care, acceptance of condition and desire for aggressive care, and access to care and poor quality of care.Conclusion Participants identified potentially avoidable reasons for hospital readmission as well as causes that require rethinking regarding how community support is targeted and delivered. Participant preference for aggressive care, inability to provide self-care, and lack of caregiver support suggest the need for new and innovative mechanisms to support seriously ill community-dwelling individuals.Journal of the American Geriatrics Society 02/2015; DOI:10.1111/jgs.13238 · 4.22 Impact Factor
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ABSTRACT: The objectives were to assess the associations between fall-related injuries (FRIs) treated in the emergency department (ED) among older adults in California and contextual county-level physical, social, and economic characteristics, and to assess how county-level economic conditions are associated with FRIs when controlling for other county-level factors. Data from 2008 California ED discharge, Medicare Impact File, and County Health Rankings were used. Random effects logistic regression models estimated contextual associations between county-level factors representing economic conditions, the built environment, community safety, access to care, and obesity with patient-level FRI treatment among 1,712,409 older adults, controlling for patient-level and hospital-level characteristics. Patient-level predictors of FRI treatment were consistent with previous studies not accounting for contextual associations. Larger and rural hospitals had higher odds of FRI treatment, while teaching and safety net hospitals had lower odds. Better county economic conditions were associated with greater odds (ß = 0.73, P = 0.001) and higher county-level obesity were associated with lower odds (ß =-0.37, P = 0.004), but safer built environments (ß =-0.31, P = 0.38) were not associated with FRI treatment. The magnitude of association between county-level economic conditions and FRI treatment attenuated with the inclusion of county-level obesity rates. FRI treatment was most strongly and consistently related to more favorable county economic conditions, suggesting differences in treatment or preferences for treatment for FRIs among older individuals in communities of varying resource levels. Using population health data on FRIs, policy makers may be able to remove barriers unique to local contexts when implementing falls prevention educational programs and built environment modifications. (Population Health Management 2015;xx:xxx–xxx)Population Health Management 04/2015; DOI:10.1089/pop.2014.0156 · 1.35 Impact Factor