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

Abstract

Context Understanding whether and why there are racial disparities in readmissions has implications for efforts to reduce readmissions. Objective To determine whether black patients have higher odds of readmission than white patients, and if these disparities are related to where black patients receive care. Design Using national Medicare data, we examined 30-day readmissions after hospitalization for acute myocardial infarction (AMI), 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 versus non-minority-serving hospitals. Setting U.S. hospitals. Participants 3.1 million Medicare fee-for-service recipients, discharged in 2006–2008. Intervention None. Main Outcome Measure Risk-adjusted odds of 30-day readmission. Results Overall, black patients had higher readmission rates than white patients (24.8% versus 22.6%, odds ratio [OR] 1.13, 95% confidence interval [CI] 1.11 to 1.14, p<0.001); patients from minority-serving hospitals had higher readmission rates than those from non-minority-serving hospitals (25.5% versus 22.0%, OR 1.23, 95% CI 1.20, 1.27, p<0.001). Among AMI patients, using white patients from non-minority-serving hospitals as our reference group (readmission rate 20.9%), we found that black patients from non-minority-serving hospitals had the highest readmission rate (26.4%, OR 1.20, 95% CI 1.16, 1.23), 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 minority-serving hospitals had a 23.3% readmission rate (OR 1.35, 95% CI 1.28, 1.42, 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. Conclusions Among elderly Americans, black patients were more likely to be readmitted after hospitalization for three common conditions, a gap that was related to both race and to the site where care was received.

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A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

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Determinants of between‐hospital variations in outcomes for patients admitted with COPD exacerbations: findings from a nationwide clinical audit ( AUDIPOC ) in Spain

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