Residents of disadvantaged neighborhoods who are discharged from safety-net hospitals have high hospital readmission risk

1. In this retrospective observational study, the authors observed that residing in a disadvantaged neighborhood and being discharged from a safety-net hospital were independently associated with an increased 30-day risk of readmission.

2. There was a higher association observed between readmission risk and the hospital’s safety-net index compared to the patient’s neighborhood disadvantage status.

Evidence Rating Level: 2 (Good)

Study Rundown: The term safety-net hospital refers to a center that cares for a large number of significantly disadvantaged patients. The authors of this study evaluated the independent contributions of patients’ neighborhoods and the hospital’s service area with respect to the risk of 30-day readmission. The primary outcome measured was unplanned 30-day hospital readmission. Through this retrospective observational study, the authors found that residing in a disadvantaged neighborhood and being discharged from a safety net hospital were independently associated with an increased 30-day readmission risk among similar patients. Further, a greater association was found with the hospital’s safety-net index compared to the patient’s neighborhood disadvantage status. Since this study took place in Maryland, and involved residents discharged from a Maryland hospital in 2015, a main limitation of this study is its generalizability..

Click to read the study in Annals of Internal Medicine

Relevant Reading: Changes to Racial Disparities in Readmission Rates After Medicare’s Hospital Readmissions Reduction Program Within Safety-Net and Non–Safety-Net Hospitals

In-Depth [retrospective cohort]: The authors conducted a retrospective observational study utilizing Maryland’s data during the 2015 fiscal year (1 July 2014 to 30 June 2015). They assessed two main risk factors, hospital safety-net, which was defined as the mean disadvantage (mean ADI) of the hospital’s discharged patients, as well as the area disadvantage index (ADI) of the neighborhood where the patient lives. Clinical risk factors were controlled for during the statistical analysis. The primary study outcome was the 30-day hospital readmission; the hospital readmission rate was then defined as the number of readmissions to any Maryland hospital per 100 discharges. The authors found that 13.4% of discharged patients were readmitted to hospital within 30 days. Additionally, they observed that patients who were living in neighborhoods at the 90^th percentile of disadvantage had a readmission rate of 14.1% (95% CI, 13.6% to 14.5%). This value contrasted the ADI of similar patients living in neighborhoods at the 10^th percentile of disadvantage, where they had a readmission rate of 12.5% (CI, 11.8% to 13.2%). Regarding the safety-net index, the readmission rate was 14.8% (CI, 13.4% to 16.1%) for patients discharged from hospitals at the 90^th percentile of the safety-net index, compared to 11.6% (CI, 10.5% to 12.7%) for similar patients discharged from hospitals at the 10^th percentile of the safety-net index.

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