Association Between Racial Disparities in Hospital Length of Stay and the Hospital Readmission Reduction Program.

IF 1.5 Q3 HEALTH POLICY & SERVICES
Health Services Research and Managerial Epidemiology Pub Date : 2021-08-31 eCollection Date: 2021-01-01 DOI:10.1177/23333928211042454
Arnab K Ghosh, Orysya Soroka, Martin Shapiro, Mark A Unruh
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引用次数: 2

Abstract

Background: 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.

Objective: We examined the relationship between Medicare-insured Black-White differences in average, adjusted LOS (ALOS) and the HRRP's implementation and evaluation periods.

Methods: 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.

Results: 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, P < 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, P < 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.

Conclusion: 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.

Abstract Image

Abstract Image

Abstract Image

住院时间的种族差异与减少再入院计划之间的关系。
背景:黑人患者的平均LOS比白人患者长。较长的住院时间(LOS)可能与较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的总体种族差异。然而,目前尚不清楚HRRP是否缩小了LOS的种族差异。目的:探讨参保黑人-白人平均、调整后LOS (ALOS)差异与HRRP实施和评估期的关系。方法:使用2009-2017年纽约州、新泽西州和佛罗里达州住院患者数据集的数据,采用多变量广义回归模型进行中断时间序列分析,控制患者、疾病和医院特征。结果报告每100名招生。结果:我们发现,对于那些出院回家的人,在HRRP实施之前和之后,目标条件下黑白ALOS差异显著扩大,每100次入院增加4.15天(95% CI: 1.19至7.11,P < 0.001),但在HRRP评估期间,每个季度每100次入院减少1.84天(95% CI: -2.86至-0.82,P < 0.001);对于那些被释放到非家乡目的地的人,在HRRP期间没有显著变化,但ALOS差异在研究期间扩大。无论HRRP阶段和出院目的地如何,非靶向条件下黑白ALOS差异保持不变。结论:黑人患者的LOS增加可能在减少黑人和白人在出院回家患者中针对目标条件的30天再入院风险方面的差异中发挥了作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.60
自引率
6.20%
发文量
32
审稿时长
12 weeks
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