Key result
HRRP implementation linked to ~4-day wider Black-White length-of-stay disparities per 100 admissions.
Why the study?
Although the HRRP reduced overall racial differences in 30-day readmission risk, whether it narrowed Black-White differences in hospital length of stay remained unclear.
Does the Hospital Readmission Reduction Program (HRRP) affect racial disparities in hospital length of stay between Black and White Medicare patients?
Observational (n=17,499,053)
Yes
Does the Hospital Readmission Reduction Program (HRRP) affect racial disparities in hospital length of stay between Black and White Medicare patients?
The HRRP was associated with an initial widening followed by a narrowing of Black-White disparities in hospital length of stay for targeted conditions among patients discharged home, which may have contributed to reduced readmission disparities.
May require equity safeguards during HRRP implementation phases; leaves open whether transient LOS shifts affect readmission disparities.
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.
No takes yet. Share an insight, caveat, or question.
Ghosh et al. (2021) conducted an observational in Hospitalized Medicare beneficiaries with HRRP-targeted (acute myocardial infarction, heart failure, pneumonia) and non-targeted conditions (n=17,499,053). Hospital Readmission Reduction Program (HRRP) implementation and evaluation vs. Pre-Affordable Care Act period (2009 to Q2/2010) and White Medicare patients was evaluated on Change in slope of Black-White average adjusted length of stay (ALOS) differences per 100 admissions per year-quarter for HRRP-targeted conditions among patients discharged home (pre-ACA to HRRP implementation period) (MD 4.15 days per 100 admissions per year-quarter, 95% CI 1.19 to 7.11, p=<0.001). HRRP implementation widened Black-White adjusted length of stay differences by 4.15 days per 100 admissions (P<0.001) for targeted conditions discharged home, before narrowing in the evaluation phase.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: