title: Safety-net Hospitals Face More Barriers Yet Use Fewer Strategies to Reduce Readmissions.
abstract: US hospitals that care for vulnerable populations, "safety-net hospitals" (SNHs), are more likely to incur penalties under the Hospital Readmissions Reduction Program, which penalizes hospitals with higher-than-expected readmissions. Understanding whether SNHs face unique barriers to reducing readmissions or whether they underuse readmission-prevention strategies is important.
  
  
  
  We surveyed leadership at 1600 US acute care hospitals, of whom 980 participated, between June 2013 and January 2014. Responses on 28 questions on readmission-related barriers and strategies were compared between SNHs and non-SNHs, adjusting for nonresponse and sampling strategy. We further compared responses between high-performing SNHs and low-performing SNHs.
  
  
  
  We achieved a 62% response rate. SNHs were more likely to report patient-related barriers, including lack of transportation, homelessness, and language barriers compared with non-SNHs (P-values<0.001). Despite reporting more barriers, SNHs were less likely to use e-tools to share discharge summaries (70.1% vs. 73.7%, P<0.04) or verbally communicate (31.5% vs. 39.8%, P<0.001) with outpatient providers, track readmissions by race/ethnicity (23.9% vs. 28.6%, P<0.001), or enroll patients in postdischarge programs (13.3% vs. 17.2%, P<0.001). SNHs were also less likely to use discharge coordinators, pharmacists, and postdischarge programs. When we examined the use of strategies within SNHs, we found trends to suggest that high-performing SNHs were more likely to use several readmission strategies.
  
  
  
  Despite reporting more barriers to reducing readmissions, SNHs were less likely to use readmission-reduction strategies. This combination of higher barriers and lower use of strategies may explain why SNHs have higher rates of readmissions and penalties under the Hospital Readmissions Reduction Program.
authors.affiliation: *Department of Health Policy and Management, Harvard T.H. Chan School of Public Health †Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Cambridge ‡Department of Health Policy and Management, Harvard T.H. Chan School of Public Health §Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital ∥Department of Biostatistics, Harvard T.H. Chan School of Public Health ¶Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston #Division of Medicine, Veterans Affairs Boston Healthcare System, Cambridge, MA.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Figueroa
authors.forename: Karen E
authors.initials: KE
authors.lastname: Joynt
authors.forename: Xiner
authors.initials: X
authors.lastname: Zhou
authors.forename: Endel J
authors.initials: EJ
authors.lastname: Orav
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Jha
mesh_terms: D003144:Communication Barriers; D006703:Ill-Housed Persons; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D007802:Language; D008603:Mental Health / Q000706:statistics & numerical data; D010359:Patient Readmission; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration*; D064876:Safety-net Providers / Q000458:organization & administration* / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology; D014186:Transportation; D014481:United States