What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction, heart failure, or pneumonia (n=2588121). Intervention: Dual eligibility for Medicare and Medicaid vs. Non-dual eligible Medicare patients. Primary outcome: Within-hospital disparities in 30-day readmission (adjusted rate difference) for acute myocardial infarction (Rate difference 0.87%, p=<0.001).

January 28, 2022JAMA Health ForumOpen Access

Factors Associated With Disparities in Hospital Readmission Rates Among US Adults Dually Eligible for Medicare and Medicaid

Q: What are the key findings of this study?

Within-hospital disparities in 30-day readmission for dual-eligible patients persisted after accounting for state- and community-level factors, with an adjusted rate difference of 0.87% for acute myocardial infarction, 0.67% for heart failure, and 0.42% for pneumonia.

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Key result

Within-hospital disparities in 30-day readmission for dual-eligible patients persisted after accounting for state- and community-level factors, with an adjusted rate difference of 0.87% for acute myocardial infarction, 0.67% for heart failure, and 0.42% for pneumonia.

Why the study?

The degree to which post-hospitalization disparities for dually eligible Medicare and Medicaid patients are driven by community-level factors versus hospital quality improvement remains debated.

Are there within-hospital disparities in 30-day readmission rates between dually eligible and non-dually eligible Medicare patients hospitalized for AMI, HF, or pneumonia?

Population

475 444 AMI, 898 395 HF, and 1 214 282 pneumonia patients aged ≥65 years

Comparison

Dually eligible (DE) vs non-DE patients

Design

Retrospective cohort study

Follow-up

30 days

Authors

DSDavid M. Silvestri DGDemetri Goutos ALAnouk Lloren

Discussion

Member takes

Overview

Disparities in 30-day readmissions for dual-eligible patients persist within hospitals; leaves open whether community factors or unmeasured differences drive them.

Study Design

Type

Cohort (n=2,588,121)

Multicenter

Yes

Structured PICO

Are there within-hospital disparities in 30-day readmission rates between dually eligible and non-dually eligible Medicare patients hospitalized for AMI, HF, or pneumonia?

Population

2,588,121 Medicare patients aged 65 years or older hospitalized for acute myocardial infarction, heart failure, or pneumonia across US hospitals, evaluated for 30-day readmission disparities.

Exposure

Dual eligibility for Medicare and Medicaid (DE)

Comparator

Non-dual eligibility (non-DE)

Outcome

Within-hospital disparities in 30-day risk-adjusted readmission rates (rate difference in 30-day readmission between DE vs non-DE patients)hard clinical

Main Result

Effect estimate: Rate difference 0.87%

p-value: p=<0.001

Within-hospital disparities in 30-day readmission for dually eligible Medicare/Medicaid patients are only modestly explained by community-level factors, highlighting the need for hospital-level quality improvement to advance equity.

Limitations

May be additional social or nonsocial risk factors related to readmission that were not included
Overlooks social risk heterogeneity within communities by using community-level variables
Use of ZIP-code level data rather than more granular census tracts
Results may be less generalizable to younger dual-eligible patients or those hospitalized for other conditions

Cite This Study

Silvestri et al. (2022) conducted a cohort in Acute myocardial infarction, heart failure, or pneumonia (n=2,588,121). Dual eligibility for Medicare and Medicaid vs. Non-dual eligible Medicare patients was evaluated on Within-hospital disparities in 30-day readmission (adjusted rate difference) for acute myocardial infarction (Rate difference 0.87%, p=<0.001). Within-hospital disparities in 30-day readmission for dual-eligible patients persisted after accounting for state- and community-level factors, with an adjusted rate difference of 0.87% for acute myocardial infarction, 0.67% for heart failure, and 0.42% for pneumonia.

synapsesocial.com/papers/6a4af35c321fc44b1362b438 https://doi.org/10.1001/jamahealthforum.2021.4611

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January 28, 2022JAMA Health ForumOpen Access

Factors Associated With Disparities in Hospital Readmission Rates Among US Adults Dually Eligible for Medicare and Medicaid

View Full Paper

Ask AI

Bookmark

Key result

Why the study?

The degree to which post-hospitalization disparities for dually eligible Medicare and Medicaid patients are driven by community-level factors versus hospital quality improvement remains debated.

Are there within-hospital disparities in 30-day readmission rates between dually eligible and non-dually eligible Medicare patients hospitalized for AMI, HF, or pneumonia?

Population

475 444 AMI, 898 395 HF, and 1 214 282 pneumonia patients aged ≥65 years

Comparison

Dually eligible (DE) vs non-DE patients

Design

Retrospective cohort study

Follow-up

30 days

Authors

DSDavid M. Silvestri DGDemetri Goutos ALAnouk Lloren

Discussion

Member takes

Overview

Disparities in 30-day readmissions for dual-eligible patients persist within hospitals; leaves open whether community factors or unmeasured differences drive them.

Study Design

Type

Cohort (n=2,588,121)

Multicenter

Yes

Structured PICO

Are there within-hospital disparities in 30-day readmission rates between dually eligible and non-dually eligible Medicare patients hospitalized for AMI, HF, or pneumonia?

Population

2,588,121 Medicare patients aged 65 years or older hospitalized for acute myocardial infarction, heart failure, or pneumonia across US hospitals, evaluated for 30-day readmission disparities.

Exposure

Dual eligibility for Medicare and Medicaid (DE)

Comparator

Non-dual eligibility (non-DE)

Outcome

Within-hospital disparities in 30-day risk-adjusted readmission rates (rate difference in 30-day readmission between DE vs non-DE patients)hard clinical

Main Result

Effect estimate: Rate difference 0.87%

p-value: p=<0.001

Limitations

May be additional social or nonsocial risk factors related to readmission that were not included
Overlooks social risk heterogeneity within communities by using community-level variables
Use of ZIP-code level data rather than more granular census tracts
Results may be less generalizable to younger dual-eligible patients or those hospitalized for other conditions

Cite This Study

synapsesocial.com/papers/6a4af35c321fc44b1362b438 https://doi.org/10.1001/jamahealthforum.2021.4611

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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