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

Abstract

Background Health 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. Design This 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. Patients We identified all adults discharged from the adult hospital medicine service at UCSF Medical Center between July 2016 and June 2019. Main Measures The primary outcome was 7-day all-cause readmission back to the discharging hospital. Results There 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. Conclusions Black patients and Asian patients experienced higher rates of 7-day readmission than patients who identified as white, confirmed on adjusted analysis.

The Tea House Series: Striving Together to be Antiracist

“…25 The disparities data embedded in the survey question highlighted a racialized gap in 7-day readmission, length-of-stay, and opioid prescribing practice within the respondent's institution. 28 The theme of Data Motivates Action was expressed by nearly every respondent, exemplified by this quote: "If I see data that shows disparities that my clinical care is contributing towards, that spurns me to take discrete action." Additional themes emerged when analyzing the free text response to the question prompt: "How do you or do you not feel empowered [to address health care disparities]?"…”