Do 30-Day Postpartum Readmissions Rates Vary by Site of Care for Vulnerable Patients? [9OP]. Issue 1 (May 2017)

• Record Type: Journal Article
• Authors: Ranjit, Anju; Zogg, Cheryl; Witkop, Catherine; Little, Sarah; Haider, Adil H.; Robinson, Julian N.
• Is Part Of: Obstetrics and gynecology. Volume 129:Issue 1(2017)
• Publication Date: 2017-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000513938.07738.2e
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: To determine 30-day readmission rates following delivery in the United States, assess for access-based differences in readmission rates, and determine if differences vary by site of care. METHODS: We used Nationwide Readmissions Database to identify deliveries between January-October 2013. We categorized Medicaid, uninsured, and low-income patients as "vulnerable" and ranked hospitals by the proportion of vulnerable patients that they served. Differences in 30-day readmissions among higher (more than 74th percentile) versus lower (1-74th) vulnerable patient-serving hospitals were compared using multivariable logistic regression. Models adjusted for differences in patient demographics, comorbidities, pregnancy risk-status, type of deliveries, and hospital characteristics. RESULTS: A total of 1, 392, 622 deliveries were included, weighted to represent 3, 932, 181 deliveries nationwide. In 2013, 136 women/10, 000 deliveries (1.4%) were readmitted within 30 post-discharge days. The most common reasons for readmissions were wound infection(n=1733, 9.1%), endometritis (n=1454, 7.7%), and hypertension(n=1181, 6.2%). A total of 732, 441 (52.6%) deliveries were to vulnerable patients; 505, 807 (36.3%) received care at hospitals managing a higher proportion of such patients. 30-day readmissions were higher among vulnerable patients (1.5% vs. 1.1%, OR [95% CI]: 1.39 [1.33-1.45]). CONCLUSION: Vulnerable patients experienced higher 30-day readmission rates, regardless of site of care. While differences were marginally pronounced at hospitals managing a lower proportion of vulnerable patients, the ubiquitousness of the finding across institutions speaks to the pervasive need to address disparities in perinatal care.