MI and CHF Readmission Rates Higher in Black Patients

February 16, 2011

February 16, 2011 (Boston, Massachusetts) — Black Medicare patients are significantly more likely to be readmitted to the hospital after an initial hospitalization for congestive heart failure, acute MI, and pneumonia, according to the results of a new study [1]. In addition, patients discharged from minority-serving hospitals also had significantly higher rates of readmission compared with non–minority-serving hospitals, report investigators.

"We found that older black Medicare patients in the United States had higher 30-day readmission rates than white patients for three common medical conditions and that these differences were related, in part, to higher readmission rates among hospitals that disproportionately care for black patients," write Dr Karen Joynt (Harvard School of Public Health, Boston, MA) and colleagues in the February 16, 2011 issue of the Journal of the American Medical Association. "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."

The new report includes data from more than 3.1 million Medicare fee-for-service recipients discharged from US hospitals between 2006 and 2008. The purpose of the study, explain the researchers, was to determine whether black patients had higher rates of readmission than white patients when discharged after acute MI, congestive heart failure, and pneumonia. The authors note that hospital readmission rates have recently become the focus of policy research, as it represents an opportunity to improve quality and reduce costs.

13% More Likely to Be Readmitted at 30 Days

Overall, black patients were 13% more likely than white patients to be readmitted to the hospital at 30 days, while patients from minority-serving hospitals--the 10% of hospitals serving the most black patients--were 23% more likely to be readmitted at 30 days following discharge for MI, heart failure, and pneumonia. In terms of patients with MI, black patients were 13% more likely to be readmitted, while those treated at minority-serving hospitals were 22% more likely to return to the hospital at 30 days.

Risk-Adjusted Odds of 30-Day All-Cause Readmission by Race


Combined MI, CHF, and pneumonia, odds ratio (95% CI)

MI, odds ratio (95% CI)

CHF, odds ratio (95% CI)

Pneumonia, odds ratio (95% CI)

Black patients

1.13 (1.11–1.14)

1.13 (1.10–1.16)

1.04 (1.03–1.06)

1.15 (1.12–1.17)

White patients

1.0 (Reference)

1.0 (Reference)

1.0 (Reference)

1.0 (Reference)

Minority-serving hospitals

1.23 (1.20–1.27)

1.22 (1.17–1.27)

1.14 (1.11–1.17)

1.18 (1.14–1.22)

Non–minority-serving hospitals

1.0 (Reference)

1.0 (Reference)

1.0 (Reference)

1.0 (Reference

In additional analysis, the researchers also observed that white patients at non–minority-serving hospitals had the lowest 30-day rates of readmission while black patients at minority-serving hospitals had the highest rates of readmission. Using white patients treated at a non–minority-serving hospital as the reference group, for example, black patients at a minority-serving hospital had a 35% higher risk of readmission following MI, while black patients at a non–minority-serving hospital had a 20% higher risk of readmission. White patients treated at minority-serving hospitals also had a higher rate of readmission following MI, 23%, when compared with the reference group. Similar results were observed for congestive heart failure and pneumonia.

"We found that the association of readmission rates with the site of care was consistently greater than the association with race, suggesting that racial disparities in readmissions are, at least in part, a systems problem--the hospital at which a patient receives care appears to be at least as important as his/her race," write Joynt and colleagues.

A Failure of the Healthcare System

In an editorial accompanying the study [2], Drs Adrian Hernandez and Lesley Curtis (Duke Clinical Research Institute, Durham, NC) agree, stating it is healthcare system failure when patients are discharged without a complete understanding of their disease, how to manage symptoms, when to take their medication, and how and when to access follow-up care. Another view is that hospital readmissions might not be viewed as a failure, "but as the right care at the right time."

The editorialists state that reducing hospital admission rates and racial disparities in those rates requires evidence that doesn't exist yet, such as where the system fails and if it fails in different ways for black and white patients. "Effective approaches that address the system's shortcomings are needed," write Hernandez and Curtis. "Early outpatient follow-up may also be a strategy for reducing readmission rates, but the gains are likely modest, and other interventions will be necessary. 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."

The authors report no conflicts of interest. Hernandez reports receiving research support from Johnson & Johnson, Proventys, and Amylin and receiving honoraria from AstraZeneca, Corthera, and Amgen. Curtis reported receiving research support from Johnson & Johnson and Medtronic.


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