Disparities in 30-Day Rehospitalization Rates Among Medicare Skilled Nursing Facility Residents by Race and Site of Care

Bibliographic Data

ID9103234
AuthorsYue Li (0009-0004-9365-9070, Health Economics and Outcomes Research (United Kingdom), corresponding author), Xueya Cai (0000-0001-7922-2703, Computational Physics (United States)), Laurent G Glance (0000-0003-3381-699X, University of Rochester Medicine, corresponding author)
Year2015
Volume53
Issue12
Pages1058-1065
Publication date2015-12-01
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000441
PMID26492217
OpenAlexW1850206736
LanguageEN
Citations received2
References cited38

OBJECTIVES: To examine racial and site-of-care disparities in all-cause and potentially avoidable 30-day rehospitalization rates among a national cohort of Medicare skilled nursing facility (SNF) residents. METHODS: We analyzed the 2012 Minimum Data Set, Medicare inpatient claims, and other data. Multivariable logistic regressions were used to adjust for resident demographic, functional, and diagnostic characteristics, as well as observed SNF and geographic factors. Conditional fixed effects for SNFs were further used to adjust for both observed and unobserved factors. Independent effects of black race and site-of-care groups were estimated, where sites were defined using proportions of black Medicare admissions to the SNF. RESULTS: The 30-day all-cause and potentially avoidable rehospitalization rates were 21.9% and 8.8%, respectively, for black residents (n=120,508), and 17.7% and 7.9% for white residents (n=1,182,003). Racial disparities persisted after adjustment for resident characteristics. Moreover, risk-adjusted disparities were essentially related to the type of SNFs to which residents were admitted; after controlling for SNF sites, significant racial disparity disappeared for potentially available rehospitalizations. Black residents and white residents admitted to SNFs with high proportions of black admissions (>25%) were 31% and 19%, respectively, more likely to be rehospitalized than white residents admitted to SNFs caring for only a small percentage of black postacute residents (<3%). CONCLUSIONS: Compared with white SNF residents, black SNF residents are more likely to be rehospitalized even after adjusting for patient risk factors. Black-white disparities, especially in potentially preventable rehospitalizations, are largely due to the fact that black residents tend to be admitted to the small number of SNFs with very high rehospitalization rates

Health equity · Logistic regression · Minimum Data Set · Nursing homes · Public health · Race (biology) · Skilled Nursing Facility · Demography · Emergency Medicine · Geriatric Care and Nursing Homes · Internal Medicine · Medicine · Nursing · Nursing education and management · Palliative Care and End-of-Life Issues · Gerontology

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