Back already? It appears that older African Americans have a 13% higher chance of being readmitted to the hospital after initial discharge than whites overall, and those facilities that primarily focus on minority patients have over a quarter more chance of seeing repeat business within a month.
Dr. Karen Joynt, a health policy fellow at the Harvard School of Public Health in Boston states:
"There are significant racial disparities in readmission rates in this country. We found that both race and site of care mattered. The next step is to find out why this disparity exists. Hospital discharge is a really vulnerable time. Going home from the hospital often requires medication changes, diet changes and lifestyle changes. Even in the best case scenario, one in five is being readmitted."
Readmissions are very common in general, and reducing the rate of readmission is a focus in health-care policy. Overall, black patients have 13% greater odds of readmission within 30 days after discharge, according to the study published in the Journal of the American Medical Association (JAMA).
The average age of the patients was mid 70s to early 80s, depending on the condition. There were slightly more women included in this study than men. Among those who had been admitted for heart attack, black patients from minority-serving hospitals had the highest readmission rates of 26.4%. That translated to 35% odds of readmission for this group overall.
Dr. Adrian Hernandez, an associate professor of medicine at Duke University School of Medicine in Durham, N.C. continues:
"The biggest take-away from this study is that currently, hospital readmission is a major problem in the U.S., and we need better solutions to help prevent readmission. This was an excellent study that raises important questions. How can we get a process in place that strengthens the support received after discharge? How do we get resources that will enable hospitals to reach beyond their doors to provide services and support to vulnerable populations?"
In June 2009, the Centers for Medicare & Medicaid Services (CMS) began publicly reporting on its Hospital Compare Web site all hospitals' 30 day readmission rates for patients hospitalized and discharged with pneumonia, acute myocardial infarction (AMI), or heart failure (HF). The related JAMA article says this "shaming" of some hospitals and research showing that about 1 in 5 Medicare patients is readmitted within 30 days after hospital discharge highlighted the problem of hospital care transitions.
With passage of the Patient Protection and Affordable Care Act, CMS will begin holding hospitals accountable for their readmission rates and adjusting payments to hospitals in 2013 according to their rate of "excess" vs. "expected" Medicare readmissions for pneumonia, AMI, and HF. Hospitals will now be subject to both the "shame" of public reporting and the likely more potent "stick" of decreased reimbursement.
The Mayo Clinic defines hospital readmission as follows:
"When the patient is admitted to a hospital within seven days after being discharged from an earlier hospital stay. The standard benchmark used by the Centers for Medicare and Medicaid Services (CMS) is the 7 day readmission rate. Rates at the 75th percentile or lower are considered optimal by CMS. Patients transferred to another hospital for longer-term care will not count as a readmission. A hospital's readmission rate is calculated by dividing the total number of patients readmitted within seven days of discharge by the total number of hospital discharges."
Source: Journal of the American Medical Association
Written by Sy Kraft, B.A.