Community factors and hospital readmission rates.
OBJECTIVE
To examine the relationship between community factors and hospital readmission rates.


METHODS
We examined all hospitals with publicly reported 30-day readmission rates for patients discharged during July 1, 2007, to June 30, 2010, with acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PN). We linked these to publicly available county data from the Area Resource File, the Census, Nursing Home Compare, and the Neilsen PopFacts datasets.


METHODS
We used hierarchical linear models to assess the effect of county demographic, access to care, and nursing home quality characteristics on the pooled 30-day risk-standardized readmission rate.


METHODS
Not applicable.


RESULTS
The study sample included 4,073 hospitals. Fifty-eight percent of national variation in hospital readmission rates was explained by the county in which the hospital was located. In multivariable analysis, a number of county characteristics were found to be independently associated with higher readmission rates, the strongest associations being for measures of access to care. These county characteristics explained almost half of the total variation across counties.


CONCLUSIONS
Community factors, as measured by county characteristics, explain a substantial amount of variation in hospital readmission rates.
Health Research & Educational Trust, Chicago, IL; Division of Cardiology, Yale University School of Medicine, New Haven CT, PO Box 2254, Charlottesville, VA 22902.
Jeph
J
Herrin
Justin
J
St Andre
Kevin
K
Kenward
Maulik S
MS
Joshi
Anne-Marie J
AM
Audet
Stephen C
SC
Hines
D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D006742:Hospital Bed Capacity; D006761:Hospitals / Q000145:classification; D006801:Humans; D016014:Linear Models; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy; D009735:Nursing Homes / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000628:therapy; D012944:Social Support; D012959:Socioeconomic Factors; D014481:United States
Readmissions; community; socioeconomic status