Advertisement

Does race affect readmission to hospital after critical illness?

Published:October 02, 2008DOI:https://doi.org/10.1016/j.hrtlng.2008.01.001

      Objective

      To examine the influence of race on 7-day hospital readmission rates after discharge of critically ill patients.

      Methods

      Racial status is a risk factor for early (within 7 days) hospital readmission after initial recovery from critical illness and respiratory failure. This was a retrospective cohort study that took place in a 350-bed community hospital. Adult patients who received mechanical ventilation during their intensive care unit stay were included. Study subjects were categorized as white, black (non-Hispanic), Hispanic, and Asian/other. The main outcome measure was readmission to the hospital within 7 days of discharge. Secondary outcomes were hospital mortality and durations of hospital and intensive care unit stay. Comparisons were made across racial groups.

      Results

      Of 772 patients, 172 (22.3%) died, and 96 of the 591 discharged patients (16.2%) were readmitted within 7 days. Race was not a determinant of rapid readmission: 11.6% of blacks (P = .2), 20.6% of Hispanics (P = .3) and 16.5% of whites were readmitted within 7 days. Readmitted patients were more likely to have been discharged to a rehabilitation or extended care facility rather than to home (22.1% vs 2.2%, P < .0001). Readmitted patients tended to have had prolonged duration of mechanical ventilation ≥ 30 days (41% vs 15.1%, P = .004), to be aged ≥ 80 years (24.4% vs 13.9%, P = .005), and to be female (19.5% vs 13.7%, P = .04). Multivariate logistic regression analyses demonstrated that discharge to a place other than home (odds ratio 10.1, 95% confidence interval 3.6–28.3) and prolonged duration of mechanical ventilation (odds ratio 2.8, 95% confidence interval 1.1–6.9) were independently associated with readmission. Race did not significantly influence in-hospital mortality. Overall, the deceased were older and more likely to be female, and had longer durations of mechanical ventilation and medical and surgical intensive care unit stays.

      Conclusion

      Contrary to our hypothesis, race was not associated with rapid readmission or mortality of critically ill patients. Factors independently associated with rapid readmission were mechanical ventilation beyond 29 days and disposition to an acute rehabilitation or skilled nursing facility. Further studies are required to ascertain whether these factors are generalizable or idiosyncratic to our institution.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Coleman E.A.
        Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs.
        J Am Geriatr Soc. 2003; 51: 449-555
        • Douglas S.
        • Daly B.
        • Gordon N.
        • Brennan P.
        Survival and quality of life: short-term versus long-term mechanical ventilation.
        Crit Care Med. 2002; 30: 2655-2662
        • Nishi G.K.
        • Suh R.H.
        • Wilson M.T.
        • Cunneen S.A.
        • Marguilies D.R.
        • Shabot M.M.
        Analysis of causes and prevention of early readmission to surgical intensive care.
        Am Surg. 2003; 69: 913-917
        • Bardell T.
        • Legare J.F.
        • Buth K.J.
        • Hirsch G.M.
        • Ali I.S.
        ICU readmission after cardiac surgery.
        Eur J Cardiothorac Surg. 2003; 23: 354-359
        • Vohra H.A.
        • Goldmsith I.R.A.
        • Rosin M.D.
        • Briffa N.P.
        • Patel R.L.
        The predictors and outcome of recidivism in cardiac ICUs.
        Eur J Cardiothorac Surg. 2005; 27: 508-511
        • Kogan A.
        • Cohen J.
        • Raanani E.
        • et al.
        Readmission to the intensive care unit after “fast track” cardiac surgery: risk factors and outcomes.
        Ann Thorac Surg. 2003; 76: 503-507
        • Metnitz P.G.H.
        • Fieux F.
        • Jordan B.
        • Lang T.
        • Moreno R.
        • Gall J.R.
        Critically ill patients readmitted to intensive care units—lessons to learn?.
        Intensive Care Med. 2003; 29: 241-248
        • Alban R.F.
        • Nisim A.A.
        • Ho J.
        • Nishi G.K.
        • Shabot M.M.
        Readmission to surgical intensive care increases severity-adjusted patient mortality.
        J Trauma. 2006; 60: 1027-1031
      1. Strategic research plan and budget to reduce and ultimately eliminate health disparities: fiscal years 2002-2006.
        National Institutes of Health/US Department of Health & Human Services, 2002 (Accessed August 7, 2006)
        • Alexander M.
        • Grumbach K.
        • Remy L.
        • Rowell R.
        • Massie M.
        Congestive heart failure hospitalizations and survival in California: patterns according to ethnicity.
        Am Heart J. 1999; 137: 919-927
        • Philbin E.F.
        • DiSalvo T.G.
        Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data.
        J Am Coll Cardiol. 1999; 33: 1560-1566
        • Philbin E.F.
        • Dec G.W.
        • Jenkins P.L.
        • DiSalvo T.G.
        Socioeconomic status as an independent risk factor for hospital readmission for heart failure.
        J Am Coll Cardiol. 2001; 87: 1367-1371
        • Petersen L.A.
        • Wright S.M.
        • Peterson E.D.
        • Daley J.
        Impact of race on cardiac care and outcomes in veterans with acute myocardial infarction.
        Med Care. 2002; 40: 186-196
        • Sabatine M.S.
        • Blake G.J.
        • Drazner M.H.
        • et al.
        Influence of race on death and ischemic complications in patients with non-ST-elevation acute coronary syndromes despite modern, protocol-guided treatment.
        Circulation. 2005; 111: 1217-1224
        • Moss M.
        • Mannino D.M.
        Race and gender differences in acute respiratory distress syndrome deaths in the United States: an analysis of multiple-cause mortality data (1979-1996).
        Crit Care Med. 2002; 30: 1679-1685
        • Department of Economic and Community Development
        Table DP-2 Profile of Selected Social Characteristics: 2000.
        (2000) (Accessed August 7, 2006)
        • Daly B.J.
        • Douglas S.L.
        • Genet Kelley C.
        • O'Toole E.
        • Montenegro H.
        Trial of a disease management program to reduce hospital readmissions of the chronically critically ill.
        Chest. 2005; 128: 507-517
        • Goodney P.P.
        • Stukel T.A.
        • Lucas F.L.
        • Finlayson E.V.
        • Birkmeyer J.D.
        Hospital volume, length of stay, and readmission rates in high-risk surgery.
        Ann Surg. 2003; 238: 161-167
        • Jiang H.J.
        • Andrews R.
        • Friedman B.
        • Stryer D.
        Racial/ethnic disparities in potentially preventable readmissions: the case of diabetes.
        Am J Public Health. 2005; 95: 1561-1567
        • Sabatine M.S.
        • Blake G.J.
        • Drazner M.H.
        • et al.
        Influence of race on death and ischemic complications in patients with non-ST elevation acute coronary syndromes despite modern, protocol-guided treatment.
        Circulation. 2005; 111: 1217-1224
        • Alexander M.
        • Grumbach K.
        • Remy L.
        • Rowell R.
        • Massie B.M.
        Congestive heart failure hospitalizations and survival in California: patterns according to race/ethnicity.
        Am Heart J. 1999; 137: 919-927
        • Onukwugha E.
        • Mullins C.D.
        Racial differences in hospital discharge disposition among stroke patients in Maryland.
        Med Decis Making. 2007; 27: 233-242
        • Rathore S.S.
        • Foody J.M.
        • Wang Y.
        • et al.
        Race, quality of care, and outcomes of elderly patients hospitalized with heart failure.
        JAMA. 2003; 289: 2517-2524
        • Pappas G.
        • Hadden W.C.
        • Kozak L.J.
        • Fisher G.F.
        Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups.
        Am J Public Health. 1997; 87: 811-816
        • Hoover E.L.
        There is no scientific rationale for race-based research.
        J Natl Med Assoc. 2007; 99: 690-692
        • Evangelista L.S.
        • Dracup K.
        • Doering L.V.
        Racial differences in treatment-seeking delays among heart failure patients.
        J Card Fail. 2002; 8: 381-386