Impact of hospitals’ Referral Region racial and ethnic diversity on 30-day readmission rates of older adults

Abstract

Background: The Hospital Readmissions Reduction Program (HRRP) began decreasing Medicare payments to hospitals reporting high readmission rates for individuals over 65. Thus, financially incentivizing hospitals to improve quality performance on preventable readmissions. Well-established research indicates that minorities are more frequently readmitted to hospitals, but it is unknown if community diversity is associated with 30-day readmission rates. Objectives: To investigate the association between racial/ethnic diversity and hospitals' 30day readmission rates. Methods: We linked the 2017 HRRP, American Hospital Association (AHA) database, Area Health Resource File, US Census Bureau Current Population Survey, and the Dartmouth Atlas HRR dataset to examine 30-day readmission rate for heart failure (HF), pneumonia (PN), acute myocardial infarction (AMI), and hip replacement (HR) surgery of 4,299 hospitals across 306 HRRs. Results: Our findings indicate a statistically significant negative relationship between diversity and 30-day readmission rates for HF, PN, AMI, and HR with a hospital referral region (HRR). Thus, hospitals located in HRRs with diverse populations are more likely to have higher 30day readmission rates for all conditions under Medicare's HRRP Conclusion: Better discharge follow-up, interventions, and use of support staff aimed at meeting needs associated with differences in communities and cultures are likely to prove more fruitful than traditional one-size fits all approaches to care.

The Association Between Structural, Performance, and Community Factors and the Likelihood of Receiving a Penalty Under the Hospital Readmissions Reduction Program (Fiscal Year 2013–2019)

“…These findings are contrary to previous reporting of a negative association between racial and ethnic diversity and 30-day readmission for heart failure, acute myocardial infarction, pneumonia, and hip replacements. 41 Taken together, the findings suggest that hospitals located in counties with a majority of racial and ethnic minority residents perhaps face less risk associated with readmission than minorities in white majority counties.…”

The Black and White of Invasive Mechanical Ventilation in Advanced Dementia

“…The association between minority race and greater intensity of care at the end of life has been well documented in other clinical contexts, 5 and likely stems from a combination of patient/family (e.g., health literacy and trust), clinician (e.g., training in communication regarding goals of care and implicit bias), and health system-related factors (e.g., structural racism and payment structures). [10][11][12]25,26 Although racial differences in patient preferences have been posited as a key factor, 27 there is growing evidence that differences in preferences may reflect disparities in the quality of clinician-patient-family communication about goals of care. [28][29][30] Whether the racial differences we observed reflect disparities in care is unclear in the absence of data on patient preferences regarding end-of-life care, whether goals-of-care discussions occurred, and the quality of those discussions if they did occur.…”

“…8,9 These observed differences have been partly attributed to geographic variation in health care, particularly as racial/ethnic minorities live disproportionately in parts of the United States that have lower quality hospital care. 8,[10][11][12] Few longitudinal studies have documented whether racial/ethnic differences in endof-life care utilization for patients with advanced dementia have changed with efforts to improve communication, advance care planning, and access to hospice and palliative care services over the last decade. To this end, Mitchell and colleagues evaluated racial/ethnic differences in rates of feeding tube insertion, finding that, although rates still remained higher in black patients with advanced dementia than in whites, they had declined from 37.5% in 2000 to 17.5% in 2014.…”

“…Among those residing in nursing homes, blacks are also more likely than whites to be admitted to the hospital at the end of life and less likely to enroll in hospice 8,9 . These observed differences have been partly attributed to geographic variation in health care, particularly as racial/ethnic minorities live disproportionately in parts of the United States that have lower quality hospital care 8,10‐12 . Few longitudinal studies have documented whether racial/ethnic differences in end‐of‐life care utilization for patients with advanced dementia have changed with efforts to improve communication, advance care planning, and access to hospice and palliative care services over the last decade.…”

Geographic variation in the treatment of spinal disorders: association with health care professional availability, and population socioeconomic status, race, and ethnicity. A retrospective cohort study

“…33,34 Socioeconomic status (SES), 35 health care professional availability, 34 and population demographics 27,36 contribute to disparities in healthcare delivery and outcomes. A variety of geographic units of measurement are available to explore geographic variation, [37][38][39][40][41][42] with tradeoffs identified with each approach. 43,44 Geographic variation in the management of LBP has been described.…”