Racial disparities in rehospitalization among Medicare patients in skilled nursing facilities

Abstract

Objectives: We examined racial disparities in rehospitalization rates among a cohort of non-Hispanic White and Black Medicare beneficiaries admitted to skilled nursing facilities for postacute care.

Methods: We analyzed the 2008 national Nursing Home Minimum Data Set, augmented with other databases. We used multivariable logistic regression to estimate overall racial disparities in rehospitalization rates within 30 days and 90 days of nursing facility admission and the extent to which the disparities were explained by patient, facility, market, and state factors. Stratified analyses identified persistent disparities within patient subgroups, facility types, and states.

Results: The 30-day rehospitalization rates were 14.3% for White patients (n = 865 993) and 18.6% for Black patients (n = 94 651); the 90-day rehospitalization rates were 22.1% and 29.5%, respectively. Both patient and admitting facility characteristics accounted for a considerable portion of overall racial disparities, but disparities persisted after multivariable adjustments overall and in patient subgroups.

Conclusions: We found persistent racial disparities in rehospitalization among the nation's skilled nursing facility patients receiving postacute care. Targeted efforts are needed to remove these disparities.

FIGURE 1

Rehospitalization rates for Black and White skilled nursing facility patients by state at (a) 30 and (b) 90 days: Nursing Home Minimum Data Set, United States, January–September 2008. Note. States are sorted by rate for White patients, which is the bottom part of the histogram; the top part of each histogram highlights disparity for Black patients. States (Alaska, Hawaii, Idaho, Maine, Montana, North Dakota, New Hampshire, New Mexico, South Dakota, Vermont, and Wyoming) with fewer than 50 Black admissions were not included in the stratified analyses.

FIGURE 1

Rehospitalization rates for Black and White skilled nursing facility patients by state at (a) 30 and (b) 90 days: Nursing Home Minimum Data Set, United States, January–September 2008. Note. States are sorted by rate for White patients, which is the bottom part of the histogram; the top part of each histogram highlights disparity for Black patients. States (Alaska, Hawaii, Idaho, Maine, Montana, North Dakota, New Hampshire, New Mexico, South Dakota, Vermont, and Wyoming) with fewer than 50 Black admissions were not included in the stratified analyses.