Outcomes, ICU Use, and Length of Stay in Chronically Ill Black and White Children on Medicaid and Hospitalized for Surgery.
BACKGROUND
With increasing Medicaid coverage, it has become especially important to determine whether racial differences exist within the Medicaid system. We asked whether disparities exist in hospital practice and patient outcomes between matched black and white Medicaid children with chronic conditions undergoing surgery.


METHODS
We conducted a matched cohort study, matching 6,398 pairs within states on detailed patient characteristics using data from 25 states contributing adequate Medicaid Analytic eXtract claims for admissions of children with chronic conditions undergoing the same surgical procedures between January 1, 2009 and November 30, 2010 for ages 1 to 18 years.


RESULTS
The black patient 30-day revisit rate was 19.3% vs 19.8% in matched white patients (p = 0.61), 30-day readmission rates were 7.0% vs 6.9% (p = 0.43), and 30-day mortality rates were 0.38% vs 0.19% (p = 0.06), respectively. A higher percentage of black patients exceeded their own state's individual median length of stay (44.0% vs 39.6%; p < 0.001) and median ICU length of stay (25.9% vs 23.8%; p < 0.001). Intensive care unit use was higher in black patients (25.9% vs 23.8%; p < 0.001). After adjusting for multiple testing, only 2 states were found to differ significantly by race (New York for length of stay and New Jersey for ICU use).


CONCLUSIONS
We did not observe disparities in 30-day revisits and readmissions for chronically ill children in Medicaid undergoing surgery, and only slight differences in length of stay, ICU length of stay, and use of the ICU, where blacks displayed somewhat elevated rates compared with white controls.
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, PA Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.
Jeffrey H
JH
Silber
Paul R
PR
Rosenbaum
Shawna R
SR
Calhoun
Joseph G
JG
Reiter
Alexander S
AS
Hill
Orit
O
Even-Shoshan
William J
WJ
Greeley
D001741:Black or African American; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014481:United States; D044465:White People