Racial Disparities in 7-Day Readmissions from an Adult Hospital Medicine Service

Aksharananda Rambachan,Yalda Shahram,Alicia Fernandez,Yumiko Abe-Jones

doi:10.1007/s40615-021-01088-3

Abstract

BackgroundHealth systems have targeted hospital readmissions to promote health equity as there may be racial and ethnic disparities across different patient groups. However, 7-day readmissions have been understudied in adult hospital medicine.DesignThis is a retrospective study. We performed multivariable logistic regression between patient race/ethnicity and 7-day readmission. Mediation analysis was performed for limited English proficiency (LEP) status. Subgroup analyses were performed for patients with initial admissions for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer.PatientsWe identified all adults discharged from the adult hospital medicine service at UCSF Medical Center between July 2016 and June 2019.Main MeasuresThe primary outcome was 7-day all-cause readmission back to the discharging hospital.ResultsThere were 18,808 patients in our dataset who were discharged between July 2016 and June 2019. A total of 1,297 (6.9%) patients were readmitted within 7 days. Following multivariable regression, patients who identified as Black (OR 1.35, 95% CI 1.15–1.58, p <0.001) and patients who identified as Asian (OR 1.26, 95% CI 1.06–1.50, p = 0.008) had higher odds of readmission compared to white patients. Multivariable regression at the subgroup level for CHF, COPD, and cancer readmissions did not demonstrate significant differences between the racial and ethnic groups.ConclusionsBlack patients and Asian patients experienced higher rates of 7-day readmission than patients who identified as white, confirmed on adjusted analysis.

Highlights

Health equity will only be achieved when healthcare outcomes do not vary based on patient social characteristics, such as gender, race, ethnicity, geographic location, and socioeconomic status
We examined 7-day readmissions for adults discharged from our hospital medicine service, with an analysis focused on differences between racial and ethnic groups
Patients who identified as Asian had the highest proportion of limited English proficiency (LEP) at 47%, compared to 26% for patients who identified as LatinX, 4% for patients who identified as white, and

Summary

Introduction

Health equity will only be achieved when healthcare outcomes do not vary based on patient social characteristics, such as gender, race, ethnicity, geographic location, and socioeconomic status. Readmission is a significant outcome for patients and health systems, and 30-day readmission has been associated with racial disparities [1,2,3]. Health systems have targeted hospital readmissions to promote health equity as there may be racial and ethnic disparities across different patient groups. 7-day readmissions have been understudied in adult hospital medicine. We performed multivariable logistic regression between patient race/ethnicity and 7-day readmission. Main Measures The primary outcome was 7-day all-cause readmission back to the discharging hospital. Multivariable regression at the subgroup level for CHF, COPD, and cancer readmissions did not demonstrate significant differences between the racial and ethnic groups

Methods

Results

Conclusion