Impact of socioeconomic status measures on hospital profiling in New York City.
BACKGROUND
Current 30-day readmission models used by the Center for Medicare and Medicaid Services for the purpose of hospital-level comparisons lack measures of socioeconomic status (SES). We examined whether the inclusion of an SES measure in 30-day congestive heart failure readmission models changed hospital risk-standardized readmission rates in New York City (NYC) hospitals.


RESULTS
Using a Centers for Medicare & Medicaid Services (CMS)-like model, we estimated 30-day hospital-level risk-standardized readmission rates by adjusting for age, sex, and comorbid conditions. Next, we examined how hospital risk-standardized readmission rates changed relative to the NYC mean with inclusion of the Agency for Healthcare Research and Quality (AHRQ)-validated SES index score. In a secondary analysis, we examined whether inclusion of the AHRQ SES index score in 30-day readmission models disproportionately impacted the risk-standardized readmission rates of minority-serving hospitals. Higher AHRQ SES scores, indicators of higher SES, were associated with lower odds (0.99) of 30-day readmission (P<0.019). The addition of the AHRQ SES index did not change the model's C statistic (0.63). After adjustment for the AHRQ SES index, 1 hospital changed status from worse than the NYC average to no different than the NYC average. After adjustment for the AHRQ SES index, 1 NYC minority-serving hospital was reclassified from worse to no different than average.


CONCLUSIONS
Although patients with higher SES were less likely to be admitted, the impact of SES on readmission was small. In NYC, inclusion of the AHRQ SES score in a CMS-based model did not impact hospital-level profiling based on 30-day readmission.
From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.). abb@evergreenmd.org.
Alexander B
AB
Blum
From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.).
Natalia N
NN
Egorova
From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.).
Eugene A
EA
Sosunov
From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.).
Annetine C
AC
Gelijns
From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.).
Erin
E
DuPree
From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.).
Alan J
AJ
Moskowitz
From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.).
Alex D
AD
Federman
From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.).
Deborah D
DD
Ascheim
From the Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (A.B.B.); Departments of Health Evidence & Policy (A.B.B., N.N.E., A.C.G., E.D., A.J.M., D.D.A.) and Division of General Internal Medicine (A.D.F., A.J.M.), Mount Sinai School of Medicine, New York, NY; and Division of General Internal Medicine, University of California at San Francisco and the San Francisco VA, San Francisco, CA (S.K.).
Salomeh
S
Keyhani
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D009519:New York City; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012923:Social Class; D014481:United States; D016270:United States Agency for Healthcare Research and Quality
heart failure; patient readmission; social class