Gehr Family Center for Health Systems Science, University of Southern California Keck School of Medicine, 2020 Zonal Avenue, IRD 327, Los Angeles, USA.
Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
J Gen Intern Med. 2019 Jun;34(6):878-883. doi: 10.1007/s11606-019-04841-x. Epub 2019 Feb 8.
Thirty-day readmission penalties implemented with the Hospital Readmission Reduction Program (HRRP) place a larger burden on safety-net hospitals which treat a disproportionate share of racial minorities, leading to concerns that already large racial disparities in readmissions could widen.
To examine whether there were changes in Black-White disparities in 30-day readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia following the passage and implementation of HRRP, and to compare disparities across safety-net and non-safety-net hospitals.
Repeated cross-sectional analysis, stratified by safety-net status.
1,745,686 Medicare patients over 65 discharged alive from hospitals in 5 US states: NY, FL, NE, WA, and AR.
Odds ratios comparing 30-day readmission rates following an index admission for AMI, CHF, or pneumonia for Black and White patients between 2007 and 2014.
Prior to the passage of HRRP in 2010, Black and White readmission rates and disparities in readmissions were decreasing. These reductions were largest at safety-net hospitals. In 2007, Blacks had 13% higher odds of readmission if treated in safety-net hospitals, compared with 5% higher odds in 2010 (P < 0.05). These trends continued following the passage of HRRP.
Prior to HRRP, there were large reductions in Black-White disparities in readmissions at safety-net hospitals. Although HRRP tends to assess higher penalties for safety-net hospitals, improvements in readmissions have not reversed following the implementation of HRRP. In contrast, disparities continue to persist at non-safety-net hospitals which face much lower penalties.
医院再入院率削减计划（HRRP）实施 30 天再入院处罚，使收治大量少数族裔患者的医保定点医院（安全网医院）负担加重，这导致人们担心，再入院率方面已经很大的种族差异可能会进一步扩大。
考察 HRRP 通过和实施后，急性心肌梗死（AMI）、充血性心力衰竭（CHF）或肺炎患者的黑人-白人 30 天再入院率差异是否发生变化，并比较安全网和非安全网医院之间的差异。
按安全网状态分层的重复横断面分析。
5 个美国州（纽约、佛罗里达、内布拉斯加、华盛顿和阿肯色）的 1745686 名年龄超过 65 岁的 Medicare 出院存活患者。
比较 2007 年至 2014 年 AMI、CHF 或肺炎指数入院后，黑人与白人患者 30 天再入院率的比值比。
在 2010 年 HRRP 通过之前，黑人与白人的再入院率和再入院率差异都在减少。这些减少在安全网医院最大。2007 年，与 2010 年的 5%相比，安全网医院黑人患者的再入院率高 13%（P<0.05）。这些趋势在 HRRP 通过后仍在继续。
在 HRRP 通过之前，安全网医院的黑人-白人再入院率差异已经大幅减少。尽管 HRRP 往往对安全网医院评估更高的处罚，但在 HRRP 实施后，再入院率并没有改善。相比之下，在面临处罚低得多的非安全网医院，差异仍在持续。
