Disparities in 30-Day Rehospitalization Rates Among Medicare Skilled Nursing Facility Residents by Race and Site of Care.
Disparities in 30-Day Rehospitalization Rates Among Medicare Skilled Nursing Facility Residents by Race and Site of Care.
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DOI：
10.1097/mlr.0000000000000441
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发表时间：
2015-12
期刊：
影响因子：
3
通讯作者：
Glance LG
中科院分区：
文献类型：
--
作者：
Li Y;Cai X;Glance LG
检查种族和护理地点的差异，在全原因和潜在可避免的30天再住院率中，在国家队列的医疗保险熟练护理设施(SNF)居民中。我们分析了2012年的最低数据集、医疗保险住院患者索赔和其他数据。多变量Logistic回归被用来调整居民的人口统计、功能和诊断特征，以及观察到的SNF和地理因素。SNF的条件固定效应被进一步用于对观察到的和未观察到的因素进行调整。估计了黑人种族和护理地点小组的独立影响，其中地点是使用黑人医疗保险入院SNF的比例来定义的。黑人居民(n=120508)30天全原因再住院率和潜在可避免再住院率分别为21.9%和8.8%，白人居民(n=1182003)分别为17.7%和7.9%。在对居民特征进行调整后，种族差距依然存在。此外，风险调整后的差异主要与居民被允许进入的SNF的类型有关；在控制了SNF地点后，在潜在的可用的再住院方面，显著的种族差异消失了。黑人入院比例较高(25%)的黑人住院患者和白人入院患者分别为31%和19%，比只有一小部分黑人急性发作后住院患者(<；3%)入院的白人居民更有可能再次住院。与白人SNF居民相比，黑人SNF居民即使在调整了患者的危险因素后也更有可能再次住院。黑人和白人的差异，特别是在潜在的可预防的再住院方面，很大程度上是由于黑人居民往往被接纳到数量较少的SNF，再住院率非常高。
To examine racial and site-of-care disparities in all-cause and potentially-avoidable 30-day rehospitalization rates among a national cohort of Medicare skilled nursing facility (SNF) residents. We analyzed the 2012 Minimum Data Set, Medicare inpatient claims, and other data. Multivariable logistic regressions were used to adjust for resident demographic, functional, and diagnostic characteristics, as well as observed SNF and geographic factors. Conditional fixed-effects for SNFs were further used to adjust for both observed and unobserved factors. Independent effects of Black race and site-of-care groups were estimated, where sites were defined using proportions of Black Medicare admissions to the SNF. The 30-day all-cause and potentially-avoidable rehospitalization rates were 21.9% and 8.8%, respectively, for Black residents (n=120508), and 17.7% and 7.9% for White residents (n=1182003). Racial disparities persisted after adjustment for resident characteristics. Moreover, risk-adjusted disparities were essentially related to the type of SNFs to which residents were admitted; after controlling for SNF sites, significant racial disparity disappeared for potentially-available rehospitalizations. Black residents and white residents admitted to SNFs with high proportions of Black admissions (>25%) were 31% and 19%, respectively, more likely to be rehospitalized than White residents admitted to SNFs caring for only a small percentage of Black post-acute residents (<3%). Compared to White SNF residents, Black SNF residents are more likely to be rehospitalized even after adjusting for patient risk factors. Black-white disparities, especially in potentially-preventable rehospitalizations, are largely due to the fact that Black residents tend to be admitted to the small number of SNFs with very high rehospitalization rates.