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30-day readmission rates following labor & delivery in relation to insurance payer status, race and ethnicity, and income status
Abstract Number: T1B-2
Abstract Type: Original Research
Hospital readmission rates are increasingly being used as quality of care indicators. The Hospital Readmission Reduction Program links hospital reimbursement for certain medical and surgical conditions to risk adjusted rates. Critics of such programs have raised concern that payment schemes are skewed secondary to inter-hospital practice/population differences. Currently there is a paucity of original research examining post-partum readmissions. Aseltine et al. using statewide data from Connecticut (2005-2012) showed that compared to White women, Blacks were twice as likely and Hispanics 40–50% more likely to be readmitted within 30 days of vaginal or cesarean delivery. Herein, we seek to update and expand upon the existing literature involving 30-day readmissions and their association with social determinants of health after delivery in a multi-state analysis.
Using data from the State Inpatient Databases (2007-2014) from California, Florida, New York, and Maryland, we conducted a retrospective analysis of readmissions in a population of 5,003,837 singleton deliveries (ICD-9-CM codes V27.0 and V27.1). The study was approved by our Institutional Review Board. Descriptive statistics by 30-day readmission status were calculated, and we fit a multilevel multivariate logistic regression model for this outcome adjusting for patient demographics (race/ethnicity, insurance payer, median income quartile), hospital characteristics, delivery type (vaginal, operative, or Cesarean), length of stay and total hospital charges for primary visit, and Elixhauser and other comorbidities related to pregnancy. Hospital served as the clustering variable. Results are expressed as odds ratio (OR). All P values are two-sided with statistical significance evaluated at an alpha level of 0.05.
4,721,288 patients from 584 hospitals were included in our multivariate analysis. 1.24% of patients experienced a 30-day readmission. Average age for readmitted patients was 28.81 years (SD 6.35) compared to 28.74 (SD 5.99) for non-readmitted patients. After statistical adjustment, Black and Hispanic patients were 41% and 9% more likely than Whites to be readmitted up to 30 days post-delivery (Blacks: OR 1.41, 95% CI 1.37-1.44; Hispanics: OR 1.09, 95% CI 1.06-1.12). Additionally, patients on public insurance (Medicare or Medicaid) compared to Private Insurance, patients with more baseline comorbidities, and patients who underwent a Cesarean section (OR: 1.79, 95% CI: 1.75-1.82) were more likely to be readmitted. Patients residing in the highest median income quartile (OR 0.96, 95% CI 0.95-0.99) were less likely to be readmitted.
Our results identified racial, ethnic, and socioeconomic disparities in post-partum readmissions across four geographically diverse states, representing >25% of the United States’ population. Future research should further identify social determinants of health with an eye towards implementing strategies to ameliorate these present differences.