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Racial/Ethnic Disparities in Interhospital Transfer for Conditions With a Mortality Benefit to Transfer Among Patients With Medicare.
JAMA Netw Open. 2021 03 01; 4(3):e213474.JN

Abstract

Importance

Interhospital transfer (IHT) of patients is a common occurrence in modern health care. Racial/ethnic disparities are prevalent throughout US health care, but their presence in IHT is not well characterized.

Objective

To determine if there are racial/ethnic disparities in IHT for medical diagnoses for which IHT is associated with a mortality benefit.

Design, Setting, and Participants

This cross-sectional analysis used 2013 data from the Center for Medicare & Medicaid Services 100% Master Beneficiary Summary and Inpatient Claims merged with 2013 American Hospital Association data. Individuals with Medicare aged 65 years or older continuously enrolled in Medicare Part A and B with an inpatient hospitalization claim in 2013 for primary diagnosis of acute myocardial infarction, stroke, sepsis, or respiratory diseases were included. Data analysis occurred from November 2019 through July 2020.

Exposures

Race/ethnicity.

Main Outcomes and Measures

The primary outcome of interest was IHT. For the primary analysis, a series of logistic regression models were created to estimate the adjusted odds of IHT for Black and Hispanic patients compared with White patients, controlling for patient clinical and demographic variables and incorporating hospital fixed effects. In secondary analyses, subgroup analyses were conducted by diagnosis, hospital teaching status, and hospitalization to hospitals in the top decile of Black and Hispanic patient proportion.

Results

Among 899 557 patients, 734 958 patients were White (81.7%), 84 544 patients were Black (9.4%), and 47 588 patients were Hispanic (5.3%); there were 418 683 men (46.5%), and 306 215 patients (34.0%) were older than 84 years. The mean (SD) age was 76.8 (7.5) years. Among all patients, 20 171 White patients (2.7%), 1913 Black patients (2.3%), and 1062 Hispanic patients (2.2%) underwent IHT. After controlling for patient variables and hospital fixed effects, Black patients had a persistently lower odds of IHT (adjusted odds ratio, 0.87; 95% CI, 0.81-0.92; P < .001), while Hispanic patients had higher odds of IHT (adjusted odds ratio, 1.14; 95% CI, 1.05-1.24; P = .002) compared with White patients.

Conclusions and Relevance

This national evaluation of IHT among patients hospitalized with diagnoses previously found to have mortality benefit with transfer found that, compared with White patients, Black patients had persistently lower adjusted odds of transfer after accounting for patient and hospital characteristics and measured across various hospital settings. Meanwhile, Hispanic patients had higher adjusted odds of transfer. This research highlights the need for the development of strategies to mitigate disparate transfer practices by patient race/ethnicity.

Authors+Show Affiliations

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts.Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Harvard Medical School, Boston, Massachusetts. Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.Harvard Medical School, Boston, Massachusetts. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.Harvard Medical School, Boston, Massachusetts. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

33769508

Citation

Shannon, Evan Michael, et al. "Racial/Ethnic Disparities in Interhospital Transfer for Conditions With a Mortality Benefit to Transfer Among Patients With Medicare." JAMA Network Open, vol. 4, no. 3, 2021, pp. e213474.
Shannon EM, Zheng J, Orav EJ, et al. Racial/Ethnic Disparities in Interhospital Transfer for Conditions With a Mortality Benefit to Transfer Among Patients With Medicare. JAMA Netw Open. 2021;4(3):e213474.
Shannon, E. M., Zheng, J., Orav, E. J., Schnipper, J. L., & Mueller, S. K. (2021). Racial/Ethnic Disparities in Interhospital Transfer for Conditions With a Mortality Benefit to Transfer Among Patients With Medicare. JAMA Network Open, 4(3), e213474. https://doi.org/10.1001/jamanetworkopen.2021.3474
Shannon EM, et al. Racial/Ethnic Disparities in Interhospital Transfer for Conditions With a Mortality Benefit to Transfer Among Patients With Medicare. JAMA Netw Open. 2021 03 1;4(3):e213474. PubMed PMID: 33769508.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial/Ethnic Disparities in Interhospital Transfer for Conditions With a Mortality Benefit to Transfer Among Patients With Medicare. AU - Shannon,Evan Michael, AU - Zheng,Jie, AU - Orav,E John, AU - Schnipper,Jeffrey L, AU - Mueller,Stephanie K, Y1 - 2021/03/01/ PY - 2021/3/26/entrez PY - 2021/3/27/pubmed PY - 2021/6/9/medline SP - e213474 EP - e213474 JF - JAMA network open JO - JAMA Netw Open VL - 4 IS - 3 N2 - Importance: Interhospital transfer (IHT) of patients is a common occurrence in modern health care. Racial/ethnic disparities are prevalent throughout US health care, but their presence in IHT is not well characterized. Objective: To determine if there are racial/ethnic disparities in IHT for medical diagnoses for which IHT is associated with a mortality benefit. Design, Setting, and Participants: This cross-sectional analysis used 2013 data from the Center for Medicare & Medicaid Services 100% Master Beneficiary Summary and Inpatient Claims merged with 2013 American Hospital Association data. Individuals with Medicare aged 65 years or older continuously enrolled in Medicare Part A and B with an inpatient hospitalization claim in 2013 for primary diagnosis of acute myocardial infarction, stroke, sepsis, or respiratory diseases were included. Data analysis occurred from November 2019 through July 2020. Exposures: Race/ethnicity. Main Outcomes and Measures: The primary outcome of interest was IHT. For the primary analysis, a series of logistic regression models were created to estimate the adjusted odds of IHT for Black and Hispanic patients compared with White patients, controlling for patient clinical and demographic variables and incorporating hospital fixed effects. In secondary analyses, subgroup analyses were conducted by diagnosis, hospital teaching status, and hospitalization to hospitals in the top decile of Black and Hispanic patient proportion. Results: Among 899 557 patients, 734 958 patients were White (81.7%), 84 544 patients were Black (9.4%), and 47 588 patients were Hispanic (5.3%); there were 418 683 men (46.5%), and 306 215 patients (34.0%) were older than 84 years. The mean (SD) age was 76.8 (7.5) years. Among all patients, 20 171 White patients (2.7%), 1913 Black patients (2.3%), and 1062 Hispanic patients (2.2%) underwent IHT. After controlling for patient variables and hospital fixed effects, Black patients had a persistently lower odds of IHT (adjusted odds ratio, 0.87; 95% CI, 0.81-0.92; P < .001), while Hispanic patients had higher odds of IHT (adjusted odds ratio, 1.14; 95% CI, 1.05-1.24; P = .002) compared with White patients. Conclusions and Relevance: This national evaluation of IHT among patients hospitalized with diagnoses previously found to have mortality benefit with transfer found that, compared with White patients, Black patients had persistently lower adjusted odds of transfer after accounting for patient and hospital characteristics and measured across various hospital settings. Meanwhile, Hispanic patients had higher adjusted odds of transfer. This research highlights the need for the development of strategies to mitigate disparate transfer practices by patient race/ethnicity. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/33769508/Racial/Ethnic_Disparities_in_Interhospital_Transfer_for_Conditions_With_a_Mortality_Benefit_to_Transfer_Among_Patients_With_Medicare_ DB - PRIME DP - Unbound Medicine ER -