Disparities In Readmission Rates Research Articles

Racial disparities in readmission rates following surgical treatment of pediatric developmental dysplasia of the hip.

Across orthopedic subspecialties, significant racial disparities have been identified with regard to postoperative outcomes. Despite these findings among adult patients, the literature assessing these disparities within pediatric orthopedics is limited. The purpose of this study was to determine the independent predictors for unplanned readmission following surgical treatment of developmental dysplasia of the hip. Pediatric patients undergoing hip dysplasia surgery from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Two patient groups were defined: patients who had unplanned hospital readmission within 30days of surgery and patients who were not readmitted. Clinical characteristics assessed included gender, race, and American Society of Anesthesiologists (ASA) class. Risk factors for complications were assessed using bivariate and multivariate analysis. Of 6561 pediatric patients undergoing surgical treatment for hip dysplasia, 540 (8.2%) had unplanned readmission. On bivariate analysis, non-white race (Black, Asian, Hispanic, American Indian, and Native Hawaiian), an ASA class of III, IV, or V, pulmonary, renal, neurological, and gastrointestinal comorbidities, as well as immune disease, steroid use, and nutritional support were significantly associated with unplanned readmission (p < 0.05 for all). After controlling for confounding variables on multivariate analysis, non-white race (OR 1.46; p = 0.042) and ASA class of III-V (OR 2.21; p = 0.002) were found to be independent predictors for readmission. Clinicians should be advised of the increased readmission rates observed in non-white patients and those of higher ASA scores. Further work is needed to combat existing disparities within pediatric orthopedics.

The Effect of Medicare Shared Savings Program on Readmissions and Variations by Race/Ethnicity and Payer Status (December 9, 2020).

Accountable care organizations in the Medicare Shared Savings Program (MSSP) in the United States attempt to reduce cost and improve quality for their patients by improving care coordination across care settings. We examined the impact of hospital participation in the MSSP on 30-day readmissions for several groups of Medicare inpatients, and by race/ethnicity and payer status. A 2010-2016 Medicare Provider Analysis and Review files. With propensity score matched sample of MSSP and non-MSSP-participating hospitals, patient-level linear probability models with difference-in-differences approach were used to compare the changes in readmission rates for Medicare fee-for-service patients initially admitted for ischemic stroke, hip fracture, or total joint arthroplasty in MSSP-participating hospitals with non-MSSP-participating hospitals as well as to compare the changes in disparities in readmission rates over time. Hospital participation in MSSP was associated with further reduced readmission rate by 1.1 percentage points (95% confidence interval: -0.02 to 0.00, P<0.05) and 1.5 percentage points (95% confidence interval: -0.03 to 0.00, P=0.08) for ischemic stroke and hip fracture cohorts, respectively, compared with non-MSSP-participating hospitals, after the third year of hospital participation in the MSSP. There was no evidence that MSSP had an impact on racial/ethnic disparities, but increased disparity by payer status (dual vs. Medicare-only) was observed. These findings together suggest that MSSP accountable care organizations may take at least 3 years to achieve reduced readmissions and may increase disparities by payer status.

Racial Disparities in Readmission Rates Following Acute Myocardial Infarction in the Hospital Readmissions Reduction Program Era

Racial Disparities in Readmission Rates Following Acute Myocardial Infarction in the Hospital Readmissions Reduction Program Era

Sex differences in 30-day readmission rates, etiology, and predictors after transcatheter aortic valve replacement

BackgroundThe aim of this study is to analyze sex-specific readmission rates, etiology, and predictors of readmission after transcatheter aortic valve replacement (TAVR). Readmissions after TAVR are common, contributing to increased health care utilization and costs. Many factors have been discovered as predictors of readmission; however, sex-specific disparities in readmission rates are limited. MethodsBetween January 2012 and September 2015, adult patients after TAVR were identified using appropriate international classifications of diseases, ninth revision, clinical modification from the National Readmission Database. Incidence of unplanned 30-days readmission rate was the primary outcome of this study. In addition, this study includes sex-specific etiology and predictors of readmissions. Multivariate logistic regression was performed to analyze adjusted readmission rates. Hierarchical 2-level logistic models were used to evaluate predictors of readmission. ResultsReadmission rate at 30 days was 17.3%, with slightly higher readmission rates in women (OR 1.09; CI: 1.01–1.19, p < 0.001) after multivariate adjusted analysis. Noncardiac causes were responsible for most readmissions in both genders. Etiologies for readmissions such as arrhythmias, pulmonary complications, and infections were slightly higher in women, whereas heart failure and bleeding complications were higher in men. History of heart failure, atrial fibrillation, prior pacemaker, and renal failure significantly strongly predicted readmissions in both genders. ConclusionWomen undergoing TAVR have slightly higher 30-day all-cause readmission rates. These results indicate that women require more attention compared to men to prevent 30-day readmission. In addition, risk stratification for men and women based on predictors will help identify high-risk men and women for readmissions.

Racial Disparities in Readmission Rates among Patients Discharged to Skilled Nursing Facilities.

Prior studies have reported mixed findings about the existence of racial disparities in readmission rates among Medicare Advantage beneficiaries, but these studies used data from one state, focused on black-white disparities, and did not focus on patients discharged to skilled nursing facilities (SNFs). The objective of the study was to characterize racial and ethnic disparities in rates of 30-day rehospitalization directly from SNFs among fee-for-service and Medicare Advantage patients. A cross-sectional study of admissions to SNFs in 2015 was conducted. SNFs across the United States. The sample included 1 500 334 white, 213 848 African American, and 99 781 Hispanic Medicare patients who were admitted to 13 375 SNFs. The main outcome of interest was readmission, identified as patients sent back to any hospital directly from the SNF within 30 days of admission, as indicated on the Minimum Data Set discharge assessment. Overall readmission rates for fee-for-service patients were 16.7% (95% confidence interval [CI] = 16.7%-16.8%) for whites, 18.8% (95% CI = 18.7%-19.0%) for African Americans, and 17.4% (95% CI = 17.1%-17.7%) for Hispanics. Readmission rates in Medicare Advantage were 14.7% (95% CI = 14.5%-14.8%) for whites, 16.8% (95% CI = 16.6%-17.1%) for African Americans, and 15.3% (95% CI = 14.9%-15.6%) for Hispanics. We also found that African Americans had about 1% higher readmission rates than whites, even when they received care within the same SNF. No statistically significant differences were found in the magnitude of within-SNF racial disparities in Medicare Advantage compared with Medicare fee-for-service. We found racial disparities in readmission rates even within the same facility for both Medicare Advantage and fee-for-service beneficiaries. Intervention to reduce disparities in readmission rates, as well as more comprehensive quality measures that incorporate outcomes for Medicare Advantage enrollees, are needed. J Am Geriatr Soc 67:1672-1679, 2019.

Predictors of hospital readmission in US children and adults with atopic dermatitis

BackgroundDecreasing readmissions is a health care priority in the United States. However, little is kanown about the determinants of hospital readmissions for atopic dermatitis (AD). ObjectiveTo determine readmission rates among inpatients hospitalized for AD in the United States. MethodsWe analyzed the 2012-2014 Nationwide Readmission Database, including a representative, cross-sectional sample of hospital readmissions in the United States. ResultsOverall, 17.0% of inpatients with AD were readmitted within 1 year for all causes, including 12.5% with only a single readmission and 4.6% for AD. In multivariable Cox proportional hazards regression models, hospital readmission for AD was associated with below-median household income, being uninsured, having a prolonged initial hospitalization, but inversely associated with older age and a diagnosis of infection. Inpatients admitted for AD on a weekend, in the summer, or in autumn were more likely to be readmitted for AD. Hospital characteristics associated with readmission for AD included nonmetropolitan hospital location and hospital teaching status. ConclusionOne in 5 inpatients with AD are readmitted within 1 year for all causes. There are socioeconomic and health care disparities in readmission rates for AD.

Associations of hospital readmission in United States children and adults

Decreasing readmissions is a healthcare priority in the United States. Recent studies showed a substantial inpatient financial burden of atopic dermatitis (AD) in the United States. However, little is known about the prevalence and risk factors for hospital readmission in AD patients. We sought to determine rates and predictors of hospital readmission for AD. We analyzed data from the 2012-2014 Nationwide Readmission Database, including a representative, cross-sectional sample of hospital readmissions in the US. Bivariable and multivariable weighted Cox regression models were constructed to determine associations of patient- and hospital-level characteristics among patients readmitted with AD. Overall, the readmission rate for AD (4.6%) was significantly lower than the all-cause readmission rate (17.0%). In multivariable regression models, hospital readmission for AD was associated with below-median household income (hazard ratio [95% confidence interval]: 4.04 [1.65-9.88]), being uninsured (4.64 [1.61-13.40]), having a prolonged initial hospitalization (>6 days: 16.36 [3.18-84.08]), and cancer (175.15 [21.09-1454.49]), but inversely associated with older age (60 years: 0.02 [0.002-0.10]), hay fever (0.00 [0.00-0.00]), infection (0.10 [0.03-0.28]), autoimmune disorder (0.00 [0.00-0.00]), and obesity (0.00 [0.00-0.00]). Inpatients admitted for AD on a weekend (5.70 [2.26-14.37]), summer (4.34 [1.09-17.23]) or autumn (76.81 [12.12-486.74]) were all more likely to be readmitted for AD. Hospital characteristics associated with readmission for AD, included non-metropolitan hospital location (318.94 [11.41-8912.52]) and hospital teaching status (218.18 [15.38-3095.06]). Disparities in readmission rates suggest AD readmissions are associated with differences in socio-economic and clinical characteristics. These results have significant implications for the design of healthcare interventions to improve readmission rates.

953: Racial disparities in readmission rates following cesarean section

953: Racial disparities in readmission rates following cesarean section

Changes to Racial Disparities in Readmission Rates After Medicare’s Hospital Readmissions Reduction Program Within Safety-Net and Non–Safety-Net Hospitals

Although readmission rates are declining under Medicare's Hospital Readmissions Reduction Program (HRRP), concerns remain that the HRRP will harm quality at safety-net hospitals because they are penalized more often. Disparities between white and black patients might widen because more black patients receive care at safety-net hospitals. Disparities may be particularly worse for clinical conditions not targeted by the HRRP because hospitals might reallocate resources toward targeted conditions (acute myocardial infarction, pneumonia, and heart failure) at the expense of nontargeted conditions. To examine disparities in readmission rates between white and black patients discharged from safety-net or non-safety-net hospitals after the HRRP began, evaluating discharges for any clinical condition and the subsets of targeted and nontargeted conditions. Cohort study conducting quasi-experimental analyses of patient hospital discharges for any clinical condition among fee-for-service Medicare beneficiaries from 2007 to 2015 after controlling for patient and hospital characteristics. Changes in disparities were measured within safety-net and non-safety-net hospitals after the HRRP penalties were enforced and compared with prior trends. These analyses were then stratified by targeted and nontargeted conditions. Analyses were conducted from October 1, 2017, through August 31, 2018. Trends in 30-day readmission rates among white and black patients by quarter and differences in trends across periods. The study sample included 58 237 056 patient discharges (black patients, 9.8%; female, 57.7%; mean age [SD] age, 78.8 [7.9] years; nontargeted conditions, 50 372 806 [86.5%]). Within safety-net hospitals, disparities in readmission rates for all clinical conditions widened between black and white patients by 0.04 percentage point per quarter in the HRRP penalty period (95% CI, 0.01 to 0.07; P = .01). This widening was driven by nontargeted conditions (0.05 percentage point per quarter [95% CI, 0.01 to 0.08]; P = .006), whereas disparities for the HRRP-targeted conditions did not change (with an increase of 0.01 percentage point per quarter [95% CI, -0.07 to 0.10]; P = .74). Within non-safety-net hospitals, racial disparities remained stable in the HRRP penalty period across all conditions, whether the conditions were HRRP-targeted or nontargeted. Findings from this study suggest that disparities are widening within safety-net hospitals, specifically for non-HRRP-targeted conditions. Although increases in racial disparities for nontargeted conditions were modest, they represent 6 times more discharges in our cohort than targeted conditions.

Sa1858 - Racial Disparities in Readmission Rates, Procedures and Complications among Adults with Inflammatory Bowel Diseases

Sa1858 - Racial Disparities in Readmission Rates, Procedures and Complications among Adults with Inflammatory Bowel Diseases

Disparities in Surgical 30-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care

To determine whether black patients have higher odds of readmission than white patients after major surgery, and to ascertain whether these disparities are related to where black patients receive care. Racial disparities are known to exist for many aspects of surgical care. However, it is unknown if disparities exist in readmissions after a surgical procedure, an area which is becoming a prime focus for clinical leaders and policymakers. Using national Medicare data from 2007 to 2010, we examined 30-day readmissions for patients undergoing coronary artery bypass grafting, pulmonary lobectomy, endovascular abdominal aortic aneurysm repair, open abdominal aortic aneurysm repair, colectomy, and hip replacement. The main outcome measure was risk-adjusted odds of all-cause 30-day readmission. We used multivariate logistic regression to determine if black patients had higher readmission rates than white patients, and if so, whether this effect was mediated by the hospitals at which patients received care, or by poverty. Black patients had higher readmission rates than white patients (14.8% vs 12.8%, odds ratio [OR] 1.19; 95% confidence interval [CI], 1.16-1.22; P < 0.001). Patients undergoing major surgery at minority-serving hospitals also had higher readmission rates (14.3% vs 12.8%, OR 1.14, 95% CI 1.09-1.19; P < 0.001). In multivariate analyses, black patients at minority-serving hospitals had the highest overall odds of readmissions (OR 1.34). White patients at minority-serving hospitals (OR 1.15) and black patients at non-minority-serving hospitals (OR 1.20) also had higher odds of readmission than the reference group of white patients at non-minority-serving hospitals. Racial disparities were mediated in part by poverty. Among Medicare beneficiaries, black patients were more likely to be readmitted after hospitalization for surgical procedures. Since racial disparities in readmission rates are mediated both by patients' race and the hospital at which care is delivered, efforts at reducing disparities should focus not only on race-based measures but also on improving outcomes of care at minority-serving hospitals.

Racial Disparities in Readmission Rates Among Medicare Beneficiaries Undergoing Aortic Aneurysm Surgery

Racial Disparities in Readmission Rates Among Medicare Beneficiaries Undergoing Aortic Aneurysm Surgery

Abstract 2: Impact of Race and Hospital Racial Makeup on Readmissions for Heart Failure

Reducing racial/ethnic disparities in health care is a policy priority, and heart failure (HF) is a particularly important area of focus, not only because HF is the most common cause of hospitalizations and readmissions in the Medicare program, but because black patients suffer a disproportionate burden of this disease. Prior studies have shown that black patients may have higher readmission rates than white patients, but the reasons for these differences are unclear. We sought to determine whether racial disparities in readmission rates for HF were due to the site where black and white patients received care. We used national Medicare data from 2006-2007 to categorize hospitals based on the proportion of black patients they cared for, designating those in the top decile as “minority-serving.” We created risk-adjusted generalized linear regression models, with patient race and hospital racial makeup as our primary predictors, and 30-day readmission as our primary outcome. Forty percent of all black patients and five percent of all white patients were cared for at minority-serving hospitals. In risk-adjusted analyses, black patients had higher 30-day readmission rates than white patients (24.1% vs. 23.3%, p&lt;0.0001). However, in stratified analyses, we found that there were no disparities in readmission rates at non-minority-serving hospitals (Table), and black patients at non-minority-serving hospitals had significantly lower admission rates than white patients at minority-serving hospitals. These results were unchanged after controlling for length of stay, hospital characteristics, and proportion of Medicaid coverage in a hospital. Our findings suggest that racial disparities in readmissions are largely due to the site at which care is provided. Focusing quality improvement efforts at poor-performing, minority-serving hospitals has the potential to improve quality of care for all HF patients while simultaneously reducing disparities in HF care. Minority-serving hospitals Non-minority-serving hospitals Black patients White patients P value for comparison, black v. white Black patients White patients P value for comparison, black v. white Model 1 (Patient characteristics only) 26.2% 25.1% 0.006 23.3% 23.1% 0.33 Model 2 (Model 1 plus length of stay) 26.0% 25.1% 0.014 23.3% 23.2% 0.75 Model 3 (Model 2 plus hospital characteristics) 25.4% 24.3% 0.005 23.0% 22.8% 0.49 Model 4 (Model 3 plus percent Medicaid) 25.0% 24.0% 0.008 22.8% 23.0% 0.51

Disparities in Asthma Hospitalization in Massachusetts

We examined racial disparities in asthma morbidity in Massachusetts. We used Massachusetts case-mix data from 1994 to 2002 to screen and track individual asthma morbidity and hospitalizations, which resulted in a sample of 10145 patients who were first hospitalized for asthma between 1997 and 2000. We followed these patients for 2 years after their first hospitalization. Because asthma is widely considered a preventable cause of hospitalization, we interpreted a readmission for asthma as an indication of failed asthma management. We found substantial racial/ethnic disparities in readmission rates that persisted after control for comorbidities, payer type, and income. We estimated that the costs of repeat hospitalizations for asthma are in excess of one quarter of all asthma hospitalization costs. Racial/ethnic disparities in asthma readmission rates show that Massachusetts is not on the frontier of asthma treatment.