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. 2022 Sep;37(12):3020-3028.
doi: 10.1007/s11606-022-07488-3.

Follow-up Post-discharge and Readmission Disparities Among Medicare Fee-for-Service Beneficiaries, 2018

Andrew Anderson  1 , Carrie W Mills  2 , Jacqueline Willits  2 , Craig Lisk  2 , Jessica L Maksut  3 , Meagan T Khau  3 , Sarah Hudson Scholle  2
Affiliations

Follow-up Post-discharge and Readmission Disparities Among Medicare Fee-for-Service Beneficiaries, 2018

Andrew Anderson et al. J Gen Intern Med. 2022 Sep.

Abstract

Background: Previous studies have identified disparities in readmissions among Medicare beneficiaries hospitalized for the Hospital Readmissions Reduction Program's (HRRP's) priority conditions. Evidence suggests timely follow-up is associated with reduced risk of readmission, but it is unknown whether timely follow-up reduces disparities in readmission.

Objective: To assess whether follow-up within 7 days after discharge from a hospitalization reduces risk of readmission and mitigates identified readmission disparities.

Design: A retrospective cohort study using Cox proportional hazards models to estimate the associations between sociodemographic characteristics (race and ethnicity, dual-eligibility status, rurality, and area social deprivation), follow-up, and readmission. Mediation analysis was used to examine if disparities in readmission were mitigated by follow-up.

Participants: We analyzed data from 749,402 Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, or pneumonia, and discharged home between January 1 and December 1, 2018.

Main measure: All-cause unplanned readmission within 30 days after discharge.

Key results: Post-discharge follow-up within 7 days of discharge was associated with a substantially lower risk of readmission (HR: 0.52, 95% CI: 0.52-0.53). Across all four HRRP conditions, beneficiaries with dual eligibility and beneficiaries living in areas with high social deprivation had a higher risk of readmission. Non-Hispanic Black beneficiaries had higher risk of readmission after hospitalization for pneumonia relative to non-Hispanic Whites. Mediation analysis suggested that 7-day follow-up mediated 21.2% of the disparity in the risk of readmission between dually and non-dually eligible beneficiaries and 50.7% of the disparity in the risk of readmission between beneficiaries living in areas with the highest and lowest social deprivation. Analysis suggested that after hospitalization for pneumonia, 7-day follow-up mediated nearly all (97.5%) of the increased risk of readmission between non-Hispanic Black and non-Hispanic White beneficiaries.

Conclusions: Improving rates of follow-up could be a strategy to reduce readmissions for all beneficiaries and reduce disparities in readmission based on sociodemographic characteristics.

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Conflict of interest statement

The authors have no conflicts of interest to report. The analyses upon which this publication is based were performed under contract number HHSM-500-2016-00097G, entitled “Health Equity Innovation Incubator (HEII) to Improve Quality in Medicare,” funded by the Centers for Medicare and Medicaid Services (CMS), U.S. Department of Health and Human Services.

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