José F. Figueroa is an instructor of medicine at Harvard Medical School and an associate physician in the Department of Medicine, Brigham and Women's Hospital, both in Boston, Massachusetts.
Jie Zheng is a senior statistician at the Harvard T. H. Chan School of Public Health, in Boston.
Health Aff (Millwood). 2018 Apr;37(4):654-661. doi: 10.1377/hlthaff.2017.1034.
The Hospital Readmissions Reduction Program has been associated with improvements in readmission rates, yet little is known about its effect on racial disparities. We compared trends in thirty-day readmission rates for congestive heart failure, acute myocardial infarction, and pneumonia among non-Hispanic whites versus non-Hispanic blacks, and among minority-serving hospitals versus others. During the penalty-free implementation period (April 2010-September 2012), readmission rates improved over pre-implementation trends (January 2007-March 2010) for both whites and blacks, with a significantly greater decline among blacks than among whites (-0.45 percent versus -0.36 percent per quarter, respectively). In the period October 2012-December 2014, after penalties began, readmission improvements slowed for both races. Following a similar pattern, minority-serving hospitals saw greater reductions in readmissions than other hospitals did. Despite the narrowing of the two race-based gaps after announcement of the Hospital Readmissions Reduction Program, both persist. It remains to be seen whether new policy efforts will narrow these gaps and reduce the disproportionately high penalties that minority-serving hospitals face.
医院再入院率降低计划与再入院率的改善有关，但关于该计划对种族差异的影响知之甚少。我们比较了非西班牙裔白人与非西班牙裔黑人和少数族裔服务医院与其他医院之间充血性心力衰竭、急性心肌梗死和肺炎的 30 天再入院率的趋势。在无处罚实施期（2010 年 4 月至 2012 年 9 月），白人患者和黑人患者的再入院率都高于实施前的趋势（2007 年 1 月至 2010 年 3 月），黑人患者的下降幅度明显大于白人患者（每季度分别下降 0.45%和 0.36%）。在 2012 年 10 月至 2014 年 12 月期间，即开始实施处罚后，两个种族的再入院改善速度都有所放缓。少数民族服务医院的再入院率下降幅度大于其他医院，也呈现出类似的模式。尽管在宣布医院再入院率降低计划后，基于种族的两个差距有所缩小，但这两个差距仍然存在。新的政策努力是否会缩小这些差距并减少少数民族服务医院面临的不成比例的高额罚款，还有待观察。
