Only 17% and 30% of eligible US hospitals achieved equitable readmission rates by insurance and race, respectively, with low-cost hospitals more likely to achieve equity by insurance (OR 1.57; 95% CI 1.38-1.77).
Cross-Sectional (n=4,638)
Yes
A minority of US hospitals achieved equitable readmissions, and those that did characteristically served fewer Black patients, highlighting the impact of structural racism on hospital-level inequities.
Odds Ratio: 1.57 (95% CI 1.38–1.77)
Importance: Equity is an essential domain of health care quality. The Centers for Medicare identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value). Design, Setting, and Participants: Cross-sectional study of US hospitals eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019. Main Outcomes and Measures: We created a definition of equitable readmissions using CMS Disparity Methods, which evaluate hospitals on 2 methods: outcomes for populations at risk for disparities (across-hospital method); and disparities in care within hospitals' patient populations (within-a-single-hospital method). Exposures: Hospital patient demographics; hospital characteristics; and 3 measures of hospital performance-quality, cost, and value (quality relative to cost). Results: Of 4638 hospitals, 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% IQR, 0.2%-8.8% vs 3.3% IQR, 0.7%-10.8%, P < .01; race, 7.6% IQR, 3.2%-16.6% vs 9.3% IQR, 4.0%-19.0%, P = .01), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size; P < .01). In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions (odds ratio, 1.57 95% CI, 1.38-1.77), and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions (odds ratio, 1.14 [95% CI, 1.03-1.26), and there was no relationship between cost and value, and equity. Conclusion and Relevance: A minority of hospitals achieved equitable readmissions. Notably, hospitals with equitable readmissions were characteristically different from those without. For example, hospitals with equitable readmissions served fewer Black patients, reinforcing the role of structural racism in hospital-level inequities. Implementation of an equitable readmission measure must consider unequal distribution of at-risk patients among hospitals.
Nash et al. (Tue,) conducted a cross-sectional in Hospital readmissions (n=4,638). Low hospital costs vs. Higher hospital costs was evaluated on Equitable readmissions by insurance (OR 1.57, 95% CI 1.38-1.77). Only 17% and 30% of eligible US hospitals achieved equitable readmission rates by insurance and race, respectively, with low-cost hospitals more likely to achieve equity by insurance (OR 1.57; 95% CI 1.38-1.77).