title: Socioeconomic status and readmissions: evidence from an urban teaching hospital.
abstract: The Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program has focused attention on ways to reduce thirty-day readmissions and on factors affecting readmission risk. Using inpatient data from an urban teaching hospital, we examined how elements of individual characteristics and neighborhood socioeconomic status influenced the likelihood of readmission under a single fixed organizational and staffing structure. Patients living in high-poverty neighborhoods were 24 percent more likely than others to be readmitted, after demographic characteristics and clinical conditions were adjusted for. Married patients were at significantly reduced risk of readmission, which suggests that they had more social support than unmarried patients. These and previous findings that document socioeconomic disparities in readmission raise the question of whether CMS's readmission measures and associated financial penalties should be adjusted for the effects of factors beyond hospital influence at the individual or neighborhood level, such as poverty and lack of social support.
authors.forename: Jianhui
authors.initials: J
authors.lastname: Hu
authors.forename: Meredith D
authors.initials: MD
authors.lastname: Gonsahn
authors.forename: David R
authors.initials: DR
authors.lastname: Nerenz
mesh_terms: D000328:Adult; D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D015331:Cohort Studies; D005260:Female; D018166:Health Care Reform / Q000191:economics; D006784:Hospitals, Teaching / Q000191:economics* / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D017533:Marital Status; D008824:Michigan; D008875:Middle Aged; D015233:Models, Statistical; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data*; D011204:Poverty Areas; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012944:Social Support; D012959:Socioeconomic Factors; D014481:United States
keywords: Disparities; Health Reform; Hospitals; Medicare; Quality Of Care