Poor hospital readmission rates are often attributed to outside factors, such as socioeconomic status, access to care, and insurance coverage. However, a study published Friday in JAMA Health Forum found that community and social factors have only a modest effect on readmission rates.

Cheat sheet: Hospital readmissions reduction program

Study details and findings

For the study, researchers from Yale University, Mathematica Policy Research, Brigham and Women's Hospital, Vertex Pharmaceuticals, and George Washington University compared readmissions among individuals who were dually eligible (DE) for Medicare and Medicaid against patients who had only Medicare.

The study included 2.5 million patients ages 65 and older treated at more than 4,000 hospitals from 2014 and 2017. All patients had been hospitalized for one of three conditions: acute myocardial infarction (AMI), heart failure (HF), or pneumonia. In addition, researchers controlled for social and community factors that affect patient health: health services availability, state Medicaid policies and enrollment, and socioeconomic factors, such as lack of transportation and unemployment.

Overall, the researchers found that DE patients had higher 30-day hospital readmission rates compared with non-DE patients. The mean rate difference between DE patients and non-DE patients was 1% for AMI, 0.82% for HF, and 0.53% for pneumonia.

When social and community-level factors were taken into account, DE patients saw a modest decrease in readmission rates, but the disparity in readmission rates between the two groups remained. The mean rate difference after adjusting for community factors was 0.87% for AMI, 0.67% for HF, and 0.42% for pneumonia.

According to the authors, the hospitals whose rate differences were most affected after adjusting for community-level factors were usually large, urban, academic teaching hospitals. In comparison, hospitals whose rate differences were least affected were safety-net hospitals.

Comments

According to Modern Healthcare, the study offers a rebuttal to the notion that facilities treating a disproportionate share of low-income, poor health patients are disadvantaged relative to their peer facilities.

According to the study's authors, "Inequities in hospital readmission rates for [DE] patients are not the primary result of differences measurable across communities, highlighting that hospitals may have a distinct role in advancing equity for socioeconomically disadvantaged patients."

To reduce the disparity between DE and non-DE patients, the authors suggests that hospitals "[target] data collection and analytical resources, cultural transformation efforts, and quality improvement activities on strengthening equity in outcomes." (Gillespie, Modern Healthcare, 1/28; Silvestri et al., JAMA Health Forum, 1/28)