Thirty-day readmission rates for Medicare beneficiaries by race and site of care.
Thirty-day readmission rates for Medicare beneficiaries by race and site of care.
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DOI：
10.1001/jama.2011.123
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发表时间：
2011-02-16
影响因子：
120.7
通讯作者：
Jha, Ashish K.
中科院分区：
文献类型：
--
作者：
Joynt, Karen E.;Orav, E. John;Jha, Ashish K.
了解在重新接纳方面是否以及为什么存在种族差异，对减少重新接纳的努力具有影响。确定黑人患者是否比白色患者有更高的再入院几率，以及这些差异是否与黑人患者接受护理的地点有关。利用国家医疗保险数据，我们研究了急性心肌梗死（AMI）、充血性心力衰竭（CHF）和肺炎住院后30天的再入院情况。我们将黑人患者比例前10%的医院归类为“少数民族服务”。我们比较了黑人患者与白色患者在少数民族医院和非少数民族医院的再入院几率。美国医院3.1 2006年至2008年，医疗保险按服务收费的受益者人数为200万人。没有。30天再入院的风险调整比值。总体而言，黑人患者的再入院率高于白色患者（24.8%对22.6%，比值比[OR] 1.13，95%置信区间[CI] 1.11至1.14，p<0.001）;来自少数民族服务医院的患者比来自非少数民族服务医院的患者有更高的再入院率（25.5% vs 22.0%，OR 1.23，95% CI 1.20，1.27，p<0.001）。在AMI患者中，使用来自非少数民族服务医院的白色患者作为我们的参照组（再入院率20.9%），我们发现来自非少数民族服务医院的黑人患者再入院率最高（26.4%，OR 1.20，95% CI 1.16，1.23），而来自少数民族服务医院的白色患者的再入院率为24.6%。（OR 1.23，95% CI 1.18，1.29），少数民族医院的黑人患者有23.3%的再入院率（OR 1.35，95% CI 1.28，1.42，p<0.001）; CHF和肺炎的模式相似。在调整了包括照顾贫困患者的标志物在内的医院特征后，结果没有变化。在美国老年人中，黑人患者更有可能在三种常见疾病住院后再次入院，这一差距与种族和接受护理的地点有关。
Understanding whether and why there are racial disparities in readmissions has implications for efforts to reduce readmissions. To determine whether black patients have higher odds of readmission than white patients, and if these disparities are related to where black patients receive care. Using national Medicare data, we examined 30-day readmissions after hospitalization for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia. We categorized hospitals in the top decile of proportion of black patients as “minority-serving.” We determined the odds of readmission for black patients compared with white patients at minority-serving versus non-minority-serving hospitals. U.S. hospitals. 3.1 million Medicare fee-for-service recipients, discharged in 2006–2008. None. Risk-adjusted odds of 30-day readmission. Overall, black patients had higher readmission rates than white patients (24.8% versus 22.6%, odds ratio [OR] 1.13, 95% confidence interval [CI] 1.11 to 1.14, p<0.001); patients from minority-serving hospitals had higher readmission rates than those from non-minority-serving hospitals (25.5% versus 22.0%, OR 1.23, 95% CI 1.20, 1.27, p<0.001). Among AMI patients, using white patients from non-minority-serving hospitals as our reference group (readmission rate 20.9%), we found that black patients from non-minority-serving hospitals had the highest readmission rate (26.4%, OR 1.20, 95% CI 1.16, 1.23), while white patients from minority-serving hospitals had a 24.6% readmission rate (OR 1.23, 95% CI 1.18, 1.29) and black patients from minority-serving hospitals had a 23.3% readmission rate (OR 1.35, 95% CI 1.28, 1.42, p<0.001 for each); patterns were similar for CHF and pneumonia. The results were unchanged after adjusting for hospital characteristics including markers of caring for poor patients. Among elderly Americans, black patients were more likely to be readmitted after hospitalization for three common conditions, a gap that was related to both race and to the site where care was received.
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