Is Race a Risk Factor in Hospital Readmissions?

Findings from two studies published in the Journal of Hospital Medicine indicate that hospital patients who are African American and/or on Medicaid are at an increased risk of being readmitted to a hospital within a month of discharge.

In the first study, Nazima Allaudeen, MD, and colleagues at the University of California San Francisco (UCSF) examined the factors behind unplanned hospital readmission within 30 days, which occurs in nearly one in five Medicare patients in the US. Of the 6,805 patients admitted to UCSF hospitals between June 2006 and May 2008, 17% were readmitted within 30 days, with almost half of these (49.7%) occurring within 10 days.

African-American race (43% risk of readmission) and Medicaid as payer status (15% risk) were found to be associated with readmission after adjustment for other variables. Clinical factors linked to readmission included high-risk medications, congestive heart failure, renal disease, cancer (with and without metastasis), weight loss, and iron deficiency anemia.

“Many healthcare systems are now making efforts to improve the transition from hospital to home or nursing facility to try to reduce preventable readmissions but they need to know which patients to focus on to have the biggest impact,” said Allaudeen in a press release. “Studies like ours should give practitioners direction to non-clinical factors to identify.”

The second smaller study used detailed clinical assessments to examine a range of readmissions risk factors in patients who had two or more recent admissions. Alison Mudge, MD, and colleagues at the Royal Brisbane and Women’s Hospital, Australia, analyzed data from 142 patients over the age of 50 who were admitted between February 2006 and February 2007.

After six months, there were a total of 102 unplanned admissions to the hospital among 55 participants (38.7%). As expected, chronic disease was the strongest predictor of readmission; however, researchers also found that BMI played a key role, as 72% of underweight and 50% of obese patients were readmitted, compared to 27% of those with normal weight and 37% of those classed as overweight. Depressive symptoms were also associated with a higher risk of readmission (47% readmitted).

“Patients with multiple recent readmissions may have a unique risk factor profile, and may be a group which may particularly benefit from complex interventions, but no previous study has specifically examined risk factors in this high risk group,” said Mudge. “We sought to look specifically at health factors which we know are under-recognized in hospitals and primary care, and this showed that poor nutrition and depression are associated with higher health care use in this vulnerable subgroup.

“We hope this study might increase awareness of poor nutrition and depression as importance concurrent factors in medical illness, and encourage research into improving nutritional and depression management in medically ill patients.”

The read the Journal of Hospital Medicine studies, click on the links below:

• Redefining Readmission Risk Factors for General Medicine Patients
• Recurrent Readmissions in Medical Patients: A Prospective Study

What is the significance of these findings? Do you believe that being able to more easily identify patients at a high risk of readmission can help positives more effectively focus their resources?