Ghosh Arnab K, Soroka Orysya, Shapiro Martin, Unruh Mark A
Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA.
Department of Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, NY, USA.
Health Serv Res Manag Epidemiol. 2021 Aug 31;8:23333928211042454. doi: 10.1177/23333928211042454. eCollection 2021 Jan-Dec.
On average Black patients have longer LOS than comparable White patients. Longer hospital length of stay (LOS) may be associated with higher readmission risk. However, evidence suggests that the Hospital Readmission Reduction Program (HRRP) reduced overall racial differences in 30-day adjusted readmission risk. Yet, it is unclear whether the HRRP narrowed these LOS racial differences.
We examined the relationship between Medicare-insured Black-White differences in average, adjusted LOS (ALOS) and the HRRP's implementation and evaluation periods.
Using 2009-2017 data from State Inpatient Dataset from New York, New Jersey, and Florida, we employed an interrupted time series analysis with multivariate generalized regression models controlling for patient, disease, and hospital characteristics. Results are reported per 100 admissions.
We found that for those discharged home, Black-White ALOS differences significantly widened by 4.15 days per 100 admissions (95% CI: 1.19 to 7.11, < 0.001) for targeted conditions from before to after the HRRP implementation period, but narrowed in the HRRP evaluation period by 1.84 days per 100 admissions for every year-quarter (95% CI: -2.86 to -0.82, < 0.001); for those discharged to non-home destinations, there was no significant change between HRRP periods, but ALOS differences widened over the study period. Black-White ALOS differences for non-targeted conditions remained unchanged regardless of HRRP phase and discharge destination.
Increased LOS for Black patients may have played a role in reducing Black-White disparities in 30-day readmission risks for targeted conditions among patients discharged to home.
平均而言，黑人患者的住院时间比类似的白人患者更长。更长的住院时间（LOS）可能与更高的再入院风险相关。然而，有证据表明，医院再入院减少计划（HRRP）降低了30天调整后再入院风险中的总体种族差异。然而，尚不清楚HRRP是否缩小了这些住院时间的种族差异。
我们研究了医疗保险覆盖的黑人和白人在平均调整住院时间（ALOS）上的差异与HRRP的实施和评估期之间的关系。
使用来自纽约、新泽西和佛罗里达州的州住院数据集2009 - 2017年的数据，我们采用了中断时间序列分析，并使用多变量广义回归模型控制患者、疾病和医院特征。结果按每100次入院报告。
我们发现，对于那些出院回家的患者，在HRRP实施期之前到之后，针对目标疾病的每100次入院中，黑人和白人的ALOS差异显著扩大了4.15天（95%置信区间：1.19至7.11，P < 0.001），但在HRRP评估期，每100次入院中每年季度缩小了1.84天（95%置信区间：-2.86至-0.82，P < 0.001）；对于那些出院到非家庭目的地的患者，HRRP各阶段之间没有显著变化，但在研究期间ALOS差异扩大。无论HRRP阶段和出院目的地如何，非目标疾病的黑人和白人ALOS差异均保持不变。
黑人患者住院时间的增加可能在降低出院回家患者中目标疾病30天再入院风险的黑人和白人差异方面发挥了作用。
