Safety-net Hospitals Face More Barriers Yet Use Fewer Strategies to Reduce Readmissions

OBJECTIVE: US hospitals that care for vulnerable populations, "safety-net hospitals" (SNHs), are more likely to incur penalties under the Hospital Readmissions Reduction Program, which penalizes hospitals with higher-than-expected readmissions. Understanding whether SNHs face unique barriers to reducing readmissions or whether they underuse readmission-prevention strategies is important. DESIGN: We surveyed leadership at 1600 US acute care hospitals, of whom 980 participated, between June 2013 and January 2014. Responses on 28 questions on readmission-related barriers and strategies were compared between SNHs and non-SNHs, adjusting for nonresponse and sampling strategy. We further compared responses between high-performing SNHs and low-performing SNHs. RESULTS: We achieved a 62% response rate. SNHs were more likely to report patient-related barriers, including lack of transportation, homelessness, and language barriers compared with non-SNHs (P-values<0.001). Despite reporting more barriers, SNHs were less likely to use e-tools to share discharge summaries (70.1% vs. 73.7%, P<0.04) or verbally communicate (31.5% vs. 39.8%, P<0.001) with outpatient providers, track readmissions by race/ethnicity (23.9% vs. 28.6%, P<0.001), or enroll patients in postdischarge programs (13.3% vs. 17.2%, P<0.001). SNHs were also less likely to use discharge coordinators, pharmacists, and postdischarge programs. When we examined the use of strategies within SNHs, we found trends to suggest that high-performing SNHs were more likely to use several readmission strategies. CONCLUSIONS: Despite reporting more barriers to reducing readmissions, SNHs were less likely to use readmission-reduction strategies. This combination of higher barriers and lower use of strategies may explain why SNHs have higher rates of readmissions and penalties under the Hospital Readmissions Reduction Program

Business · Environmental health · Face (sociological concept) · Medical emergency · MEDLINE · Political science · Safety net · Healthcare Policy and Management · Heart Failure Treatment and Management · Hospital Admissions and Outcomes · Medicine

• Association of the Medicare Value-Based Purchasing Program With Changes in Patient Care Experience at Safety-net vs Non–Safety-net Hospitals

  Open Access•Nicholas Chiu, Rahul Aggarwal et al.•JAMA Health Forum•2022

  Incluir item

• Does the Merit-Based Incentive Payment System Disproportionately Affect Safety-Net Practices

  Open Access•Joshua M Liao, Amol S Navathe•JAMA Health Forum•2020

  Incluir item

• Assessment of Strategies Used in US Hospitals to Address Social Needs During the Covid-19 Pandemic

  Open Access•Jose F Figueroa, Ciara Duggan et al.•JAMA Health Forum•2022

  Incluir item

• Relative Effects of the Hospital Readmissions Reduction Program on Hospitals That Serve Poorer Patients

  Jason H Wasfy, Vijeta Bhambhani et al.•Medical Care•2019

  Incluir item

• Health Care Utilization of Individuals Affected by Homelessness

  Dana Madigan, Lee S Friedman•Medical Care•2021

  Incluir item

• Rehospitalizations among Patients in the Medicare Fee-for-Service Program

  Stephen F Jencks, Malcolm V Williams et al.•New England Journal of Medicine•2009

  Incluir item

• Quality of Care in Hospitals with a High Percent of Medicaid Patients

  Lee Goldman, L Elizabeth Goldman et al.•Medical Care•2007

  Incluir item

• Hospital Readmission Rates and Emergency Department Visits for Mental Health and Substance Abuse Conditions

  Open Access•Mark W Smith, Carol Stocks et al.•Community Mental Health Journal•2015

  Incluir item