Disparities in 30-Day Readmissions After Total Hip Arthroplasty
Disparities in 30-Day Readmissions After Total Hip Arthroplasty
复制标题
DOI：
10.1097/mlr.0000000000000421
复制
发表时间：
2015-11-01
期刊：
影响因子：
3
通讯作者：
Shi, Lizheng
中科院分区：
文献类型：
--
作者：
Oronce, Carlos Irwin A.;Shao, Hui;Shi, Lizheng
背景：政策制定者扩大了再入院处罚范围，将选择性全髋关节置换术 (THA) 纳入其中，但很少有人知道种族、社会经济地位或付款人是否存在差异。目的：确定基于种族、社会经济地位和保险类型的选择性初次全髋关节置换术再入院的差异。研究设计：本分析是一项针对因选择性全髋关节置换术出院的患者的回顾性队列研究。加州医疗保健成本和利用项目的州住院患者数据库用于确定择期初次 THA 住院指数和出院 30 天内的再住院指数。我们使用多变量逻辑回归来检查按种族、社会经济状况和保险划分的再入院差异。 受试者：受试者包括 2009 年至 2011 年 THA 后从加州医院出院的患者。 措施：风险调整后的 30 天全因再入院几率。 结果：计划外 30 天全因再入院的总体率为 4.6%。非洲裔美国人 [比值比 (OR)=1.38；考虑到合并症和医院因素时，THA 后，95% 置信区间 (CI)，1.16-1.64] 和西班牙裔（OR=1.16；95% CI，1.00-1.34）患者再入院的风险高于白人患者。然而，在调整社会经济地位和付款人后，观察到的西班牙裔患者的差异为零。较低的社会经济地位与较高的再入院几率相关（OR=1.24；95% CI，1.10-1.39）。与私人保险相比，医疗保险（OR=1.26；95% CI，1.13-1.43）、医疗补助（OR=1.86；95% CI，1.49-2.32）和无保险状态（OR=1.31；95% CI，1.01-1.69）也与再入院风险增加相关。结论：我们发现，再入院风险存在显着差异。根据种族、社会经济地位和付款人，30 天重新入院。随着重新入院处罚被广泛采用，付款人需要注意其对弱势群体的影响。
Background:Policymakers have expanded readmissions penalties to include elective total hip arthroplasties (THA), but little is known whether disparities exist on the basis of race, socioeconomic status, or payer.Objective:To identify disparities in elective primary THA readmissions based on race, socioeconomic status, and type of insurance.Research Design:This analysis is a retrospective cohort study of patients discharged for an elective THA. The Healthcare Cost & Utilization Project's State Inpatient Database from California was used to identify index hospitalizations for elective primary THA and rehospitalizations within 30 days of discharge. We used multivariate logistic regression to examine differences in readmissions by race, socioeconomic status, and insurance.Subjects:Subjects included patients discharged from California hospitals from 2009 through 2011 after THA.Measures:Risk-adjusted odds of all-cause 30-day readmission.Results:The overall rate of unplanned 30-day all-cause readmissions was 4.6%. African American [odds ratio (OR)=1.38; 95% confidence interval (CI), 1.16-1.64] and Hispanic (OR=1.16; 95% CI, 1.00-1.34) patients had a higher risk of readmission than white patients after THA, when accounting for comorbidities and hospital factors. The observed difference for Hispanic patients, however, was null after adjusting for socioeconomic status and payer. Lower socioeconomic status was associated with higher odds of readmission (OR=1.24; 95% CI, 1.10-1.39). Compared with private insurance, Medicare (OR=1.26; 95% CI, 1.13-1.43), Medicaid (OR=1.86; 95% CI, 1.49-2.32), and uninsured status (OR=1.31; 95% CI, 1.01-1.69) were also associated with increased readmission risk.Conclusions:We found significant differences in the odds of 30-day readmissions on the basis of race, socioeconomic status, and payer. As readmissions penalties become widely adopted, payers need to be mindful of their effects on vulnerable populations.