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J Bone Joint Surg Am. 2016 Aug 17;98(16):1385-91. doi: 10.2106/JBJS.15.00884.

Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Hospital Readmission Rates Following Hip and Knee Arthroplasty.

Author information

1
RAND Corporation, Pittsburgh, Pennsylvania martsolf@rand.org.
2
M.L. Barrett, Inc., San Diego, California.
3
Truven Health Analytics, Inc., Santa Barbara, California.
4
RAND Corporation, Pittsburgh, Pennsylvania kandrack@rand.org.
5
Agency for Healthcare Research and Quality, Rockville, Maryland.
6
RAND Corporation, Boston, Massachusetts Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
7
Department of Orthopaedic Surgery, UCLA Medical Center, Los Angeles, California.
8
Truven Health Analytics, Inc., Bethesda, Maryland.

Abstract

BACKGROUND:

Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospital's control, may not accurately reflect a hospital's performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA.

METHODS:

We calculated 2 sets of risk-adjusted readmission rates by (1) using the Centers for Medicare & Medicaid Services standard risk-adjustment algorithm that incorporates patient age, sex, comorbidities, and hospital effects and (2) adding race/ethnicity and socioeconomic status to the model. Using data from the Healthcare Cost and Utilization Project, 2011 State Inpatient Databases, we compared the relative performances of 1,194 hospitals across the 2 methods.

RESULTS:

Addition of race/ethnicity and socioeconomic status to the risk-adjustment algorithm resulted in (1) little or no change in the risk-adjusted readmission rates at nearly all hospitals; (2) no change in the designation of the readmission rate as better, worse, or not different from the population mean at >99% of the hospitals; and (3) no change in the excess readmission ratio at >97% of the hospitals.

CONCLUSIONS:

Inclusion of race/ethnicity and socioeconomic status in the risk-adjustment algorithm led to a relative-performance change in readmission rates following THA and TKA at <3% of the hospitals. We believe that policymakers and payers should consider this result when deciding whether to include race/ethnicity and socioeconomic status in risk-adjusted THA and TKA readmission rates used for hospital accountability, payment, and public reporting.

LEVEL OF EVIDENCE:

Prognostic Level III. See instructions for Authors for a complete description of levels of evidence.

PMID:
27535441
DOI:
10.2106/JBJS.15.00884
[Indexed for MEDLINE]

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