Readmission for AMI, HF more likely among Black than White US patients
MedWire News: US study results indicate that Black patients admitted with acute myocardial infarction (AMI) or heart failure (HF) are more likely to be readmitted within 30 days of discharge than White patients with these conditions.
"These differences were related, in part, to higher readmission rates among hospitals that disproportionately care for Black patients," comment the authors in JAMA.
However, "these associations persisted even after accounting for a series of potential confounders including markers of caring for poor patients, suggesting that measured features of hospitals and lower reimbursements alone are unlikely to explain these gaps," explain Karen Joynt (Brigham and Women's Hospital, Boston, Massachusetts) and team.
The findings come from the analysis of data for 3.1 million Medicare fee-for-service recipients (mean age 76 to 81 years; 91.3% White) discharged from US hospitals between 2006 and 2008. Minority-serving hospitals, defined as those in the highest decile for proportion of Black patients, accounted for 10% of the hospitals included in the analysis.
The overall risk for 30-day readmission was 13% higher among Black than White patients (p<0.001), and patients from minority-serving hospitals had a 23% higher risk for readmission than those from non-minority-serving hospitals (p<0.001).
When Joynt and co-authors looked specifically at AMI discharges (18.4% of total discharges), they found that Black patients had a 13% higher risk for 30-day readmission than White patients, and patients from minority-serving hospitals had a 15% higher 30-day readmission risk than those from non-minority-serving hospitals.
Similar findings were observed for HF discharges (42.5% of total discharges).
Overall, Black patients from minority-serving hospitals had the highest 30-day readmission risk of all patients (irrespective of reason for initial admission), with a 30% greater risk than White patients from non-minority-serving hospitals (p<0.001).
This trend was maintained even after adjustment for potential confounding readmission risk factors, such as race, length of initial hospital stay, and discharge destination.
In an accompanying editorial, Adrian Hernandez and Lesley Curtis, from Duke Clinical Research Institute in Durham, North Carolina, said the findings suggest that systems that aim to improve patient care by penalizing hospitals with high readmission rates "may unfairly penalize minority serving hospitals and thereby widen the gap in care for disadvantaged minorities."
Hernandez and Curtis advised of a need to address this issue as new systems of care are developed to ensure "that improvements in quality [of care] are shared by everyone."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Lauretta Ihonor