Medicaid Status, Race Linked with Hospital Readmissions

HealthLeaders Media Staff , October 15, 2010

As payers, providers and policymakers look for ways to address hospital readmissions, research published Wednesday in the Journal of Hospital Medicine offer insight into possible risk factors.

The authors of "Redefining Readmission Risk Factors for General Medicine Patients" find that being African American and receiving Medicaid are both factors.

"Though current strategies focus largely on clinical risk factors, this study shows that nonclinical factors play an equally important but underappreciated role in contributing to readmission," the authors write. They conclude that identification of these factors can help providers target interventions to potentially reduce readmissions.

In a retrospective observational study of an administrative database, Nazima Allaudeen, MD, and colleagues at the University of California San Francisco, examined the factors behind unplanned hospital readmission within 30 days.

This study looked at 6,805 patients (10,359 admissions) admitted to UCSF hospitals between June 2006 and May 2008. Seventeen percent of admissions were readmitted within 30 days, with 49.7 percent occurring within 10 days.

Both being African-American and being on Medicaid were associated with readmission, (43 percent and 15 percent increased risks of readmission respectively) after adjustment for other variables.

Of the clinical factors, high-risk medications and several comorbidities (congestive heart failure, renal disease, cancer [with and without metastasis], weight loss, and iron-deficiency anemia) were associated with readmission. Researchers also examined operational factors (e.g., weekend discharge), but none was significantly associated with readmission.

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2 comments on "Medicaid Status, Race Linked with Hospital Readmissions"

Steve Daviss MD (10/16/2010 at 2:26 PM)
Maryland is considering a potentially preventable readmission program via financial disincentives through its hospital regulated rates program (HSCRC). It identifies ANY psych or substance abuse readmission as being potentially preventable, meaning the index admission is potentially not paid for. The mental health community is concerned about unintentional consequences of this policy, planned to go into effect 2010.

Susan Ward (10/15/2010 at 9:54 AM)
One of the factors in hospital readmissions that none of the studies seem to take into consideration is "patient noncompliance". You can provide all the teaching and interventions you can think of, but if the patient is noncompliant after leaving the hospital, they are more likely to be readmitted. One intervention that the federal government does not like is "home care". Home care following a hospital admission will asssit the patient in compliance with the treatment plan developed on discharge from the hospital. However, the federal government does not see this important role that home care plays after hospital discharge.




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