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

Study Questions:

Do black patients have higher odds of readmission than white patients, and if so, are disparities related to where black patients receive care?

Methods:

Using national Medicare data, the authors evaluated 30-day readmissions after hospitalization for acute myocardial infarction (MI), congestive heart failure (CHF), and pneumonia. Hospitals in the top decile of proportion of black patients were categorized as minority-serving. The study included files of more than 3.1 million Medicare fee-for-service recipients who were discharged from US hospitals in 2006-2008. Race was determined by self-report, and all who were other than black were considered white. Readmission for black patients was compared with white patients at minority-serving versus non–minority-serving hospitals. Primary outcome was the Elixhauser risk-adjusted odds of 30-day readmission.

Results:

The study included about 4,500 hospitals with the following number of discharges: acute MI 579,492; CHF 1,346,768; and pneumonia 1,236,751. 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 < 0.001); 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 < 0.001). 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 < 0.001 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 and when excluding other ethnic minorities.

Conclusions:

Among elderly Medicare recipients, black patients were more likely to be readmitted after hospitalization for three common conditions (acute MI, CHF, and pneumonia), a gap that was related to both race and to the site where care was received.

Perspective:

A small number of hospitals provide a disproportionate share of the care for minority patients, and there is some evidence that these hospitals have worse performance on processes of care. The limitations of this study included the lack of data on specific treatments in-hospital and upon discharge, and whether these differed between black and white patients. Similarly, there were no data on the use and availability of subacute and home care programs. The results support the authors' suggestion: ‘Spur clinical leaders and policy makers to find new ways to reduce disparities in this important health outcome.’

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Myocardial Infarction, Pneumonia, European Continental Ancestry Group, Heart Failure, Medicare, African Continental Ancestry Group, Hospitalization, United States


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