title: Thirty-day readmission rates for Medicare beneficiaries by race and site of care.
abstract: BACKGROUND
  Understanding whether and why there are racial disparities in readmissions has implications for efforts to reduce readmissions.
  
  
  OBJECTIVE
  To determine whether black patients have higher odds of readmission than white patients and whether these disparities are related to where black patients receive care.
  
  
  METHODS
  Using national Medicare data, we examined 30-day readmissions after hospitalization for acute myocardial infarction (MI), congestive heart failure (CHF), and pneumonia. We categorized hospitals in the top decile of proportion of black patients as minority-serving. We determined the odds of readmission for black patients compared with white patients at minority-serving vs non-minority-serving hospitals.
  
  
  METHODS
  Medicare Provider Analysis Review files of more than 3.1 million Medicare fee-for-service recipients who were discharged from US hospitals in 2006-2008.
  
  
  METHODS
  Risk-adjusted odds of 30-day readmission.
  
  
  RESULTS
  Overall, black patients had higher readmission rates than white patients (24.8% vs 22.6%, odds ratio [OR], 1.13; 95% confidence interval [CI], 1.11-1.14; P < .001); patients from minority-serving hospitals had higher readmission rates than those from non-minority-serving hospitals (25.5% vs 22.0%, OR, 1.23; 95% CI, 1.20-1.27; P < .001). Among patients with acute MI and using white patients from non-minority-serving hospitals as the reference group (readmission rate 20.9%), black patients from minority-serving hospitals had the highest readmission rate (26.4%; OR, 1.35; 95% CI, 1.28-1.42), while white patients from minority-serving hospitals had a 24.6% readmission rate (OR, 1.23; 95% CI, 1.18-1.29) and black patients from non-minority-serving hospitals had a 23.3% readmission rate (OR, 1.20; 95% CI, 1.16-1.23; P < .001 for each); patterns were similar for CHF and pneumonia. The results were unchanged after adjusting for hospital characteristics including markers of caring for poor patients.
  
  
  CONCLUSIONS
  Among elderly Medicare recipients, black patients were more likely to be readmitted after hospitalization for 3 common conditions, a gap that was related to both race and to the site where care was received.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. kjoynt@partners.org
authors.forename: Karen E
authors.initials: KE
authors.lastname: Joynt
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Jha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006333:Heart Failure; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009203:Myocardial Infarction; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia; D012189:Retrospective Studies; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American