Reducing Racial Disparities in Hospital Readmissions and Health Care

Hernandez AF, Curtis LH. Minding the gap between efforts to reduce readmissions and disparities. JAMA2011;305(7):715-716.

By Kim L. Farina, PhD

Investigators from the Duke Center for Education and Research on Therapeutics (CERT), Adrian F. Hernandez, M.D., M.H.S., and Lesley H. Curtis, Ph.D., published an editorial in response to new data from a study on hospital-readmissions rates among Medicare beneficiaries in the United States. The editorial, published in the February 16, 2011, issue of the Journal of the American Medical Association, discussed the need for effective strategies that address the shortcomings of the U.S. health care system with respect to racial disparities in both hospital-readmission rates and the provision of health care. The results of the study, conducted by Joynt and colleagues, were published in the same issue of the journal.

In their editorial, Hernandez and Curtis provided an overview of the problem of racial and ethnic disparities and of the validity of using hospital-readmission rates as a measure of hospital quality. They also discussed related gaps in knowledge, critical research needs, and potential problems with risk models currently used by the Centers for Medicare & Medicare Services to compare hospital outcomes. They call for vigilance in evaluations of the effectiveness of new monitoring technologies and for new studies that will establish the evidence base for implementing effective strategies. Finally, they caution that some quality-improvement strategies being developed and implemented may inadvertently reward the rich and penalize the poor.

"Rather than a one-size-fits-all approach, programs should be developed that address the specific needs of vulnerable patients and the hospitals that care for them. Hospitals in one area of the country may have different needs than hospitals in other areas, because of local infrastructure, resources, access to care, and integration of outpatient practices. To varying degrees, hospitals face enduring extrinsic problems, such as patient populations with inadequate social support, less-healthy lifestyles, and higher rates of mental illness, as well as factors directly related to heart failure, acute myocardial infarction, and pneumonia. Policies that promote care outside the hospital in areas with these challenges are needed to ensure that vulnerable patient populations do not continue to receive the majority of their health care in hospital settings."

In their study, Joynt and colleagues analyzed 2006-2008 national Medicare data for patients hospitalized for acute myocardial infarction, congestive heart failure, or pneumonia. Their analysis showed that elderly black patients who are Medicare beneficiaries have a higher risk-adjusted 30-day hospital-readmission rate for heart failure, myocardial infarction, and pneumonia when compared to white patients hospitalized for the same conditions.

References

1. Hernandez AF, Curtis LH. Minding the gap between efforts to reduce readmissions and disparities. JAMA2011;305(7):715-716.
2. Joynt KE, Orav EJ, Jha AK. Thirty-day readmission rates for Medicare beneficiaries by race and site of care.JAMA. 2011;305(7):675-681.

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