Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care

Department of Health Policy and Management, Harvard School of Public Health, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 02/2011; 305(7):675-81. DOI: 10.1001/jama.2011.123
Source: PubMed


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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    • "hospitals serving poorer communities and having a larger share of uninsured and Medicaid populations have significantly higher rates of hospital readmissions than those in wealthier communities serving well-insured individuals (Arbaje et al. 2008; Joynt et al. 2011). "
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    • "Several factors were noted to be associated with increased readmission rates for patients with CHF. These included being discharged from a publically owned hospital in a county with low median income, a hospital lacking cardiac services, small hospitals and units with lower nursing staffing (Joynt, et al, 2011 "
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    • "Westert et al. (2002) conducted an international study, including three U.S. states and three countries, to find patterns in the profiles of readmitted patients. The findings are divided into demographic and social factors, clinical factors (Billings et al. 2006, Southern et al. 2004), and hospital operations factors (Benbassat and Taragin 2000, Davidson et al. 2007, Joynt et al. 2011, Scuteri et al. 2011, VanSuch et al. 2006, Westert et al. 2002). A study of 26 readmission risk-prediction models concluded that after reviewing 7,843 citations, none of the models analyzed could suitably predict future hospital readmissions (Kansagara et al. 2011). "
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