• Stephen F Jencks, Alyson Schuster, Geoff B Dougherty, Sule Gerovich, Jane E Brock, and Kind Amy J H AJH University of Wisconsin School of Medicine and Public Health and Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Hospital,.
• Baltimore, Maryland (S.F.J.).
• Ann. Intern. Med. 2019 Jul 16; 171 (2): 91-98.

BackgroundSafety-net hospitals have higher-than-expected readmission rates. The relative roles of the mean disadvantage of neighborhoods the hospitals serve and the disadvantage of individual patients in predicting a patient's readmission are unclear.ObjectiveTo examine the independent contributions of the patient's neighborhood and the hospital's service area to risk for 30-day readmission.DesignRetrospective observational study.SettingMaryland.ParticipantsAll Maryland residents discharged from a Maryland hospital in 2015.MeasurementsPredictors included the disadvantage of neighborhoods for each Maryland resident (area disadvantage index) and the mean disadvantage of each hospital's discharged patients (safety-net index). The primary outcome was unplanned 30-day hospital readmission. Generalized estimating equations and marginal modeling were used to estimate readmission rates. Results were adjusted for clinical readmission risk.Results13.4% of discharged patients were readmitted within 30 days. Patients living in neighborhoods at the 90th percentile of disadvantage had a readmission rate of 14.1% (95% CI, 13.6% to 14.5%) compared with 12.5% (CI, 11.8% to 13.2%) for similar patients living in neighborhoods at the 10th percentile. Patients discharged from hospitals at the 90th percentile of safety-net status had a readmission rate of 14.8% (CI, 13.4% to 16.1%) compared with 11.6% (CI, 10.5% to 12.7%) for similar patients discharged from hospitals at the 10th percentile of safety-net status. The association of readmission risk with the hospital's safety-net index was approximately twice the observed association with the patient's neighborhood disadvantage status.LimitationsGeneralizability outside Maryland is unknown. Confounding may be present.ConclusionIn Maryland, residing in a disadvantaged neighborhood and being discharged from a hospital serving a large proportion of disadvantaged neighborhoods are independently associated with increased risk for readmission.Primary Funding SourceNational Institute on Minority Health and Health Disparities and Maryland Health Services Cost Review Commission.

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