Race, ethnicity and income are all factors that affect hospital readmission rates and readmission costs for patients with chronic obstructive pulmonary disease, according to a September statistical brief from the federal Agency for Healthcare Research and Quality.
For patients age 40 and over with the disease, hospital readmissions happened most frequently among African American patients and for those living in lower-income areas. But for Asian and Pacific Islander patients, readmission costs were the highest.
The report found that within 30 days of initial treatment, readmissions were 30 percent higher among blacks than Hispanics or Asians and Pacific Islanders and about 9 percent higher than whites in 2008.
Chronic obstructive pulmonary disease (COPD) is a progressive disease that makes it difficult for a person to breathe. The disease is most often caused by smoking and can cause coughing, large amounts of mucus, wheezing, shortness of breath, chest tightness and other symptoms.
Higher rates of hospital readmissions and unexplained variations of these rates may indicate problems in transitions of care and outpatient management following discharge, the report says.
Based on data from 2003 to 2004, 22.6 percent of fee-for-service Medicare beneficiaries admitted to the hospital for COPD were readmitted within 30 days.
Across 15 states studied in 2008, there were 190,700 initial hospital admissions with a principal diagnosis of COPD among patients 40 and older. The 30-day readmission rate for patients whose primary cause of readmission was the disease was 7.1 percent. The readmission rate for patients with any diagnosis – but not necessary the main cause of readmission – of the disease was 17.3 percent.
Readmissions were more likely for some groups of patients than others. For example, among African Americans, 8 percent of patients were readmitted to a hospital within 30 days compared to 6.1 percent among Hispanic, Asian and Pacific Islander patients. Among whites, the readmission rate was 7.2 percent for patients with COPD as the principal diagnosis.
Among COPD patients residing in the lowest income areas, the readmission rate was 22 percent higher than among patients from the highest income areas; 7.8 percent of patients in poorer areas were readmitted compared to 6.4 percent of patients in wealthier areas.
Across the 15 states studied, 30-day readmission rates were 13 percent higher among males – 7.6 percent of men with the disease were readmitted compared to 6.7 percent of female patients.
Costs were consistently higher for readmissions than for initial hospital stays. On average, costs for a 30-day readmission with COPD as the main diagnosis were 18 percent higher than for the original hospital stay – $8,400 for a readmission compared to $7,100 for the first stay. For readmissions when chronic obstructive pulmonary disease was listed as any diagnosis, cost per case was an average of $10,900.
Costs for readmitting patients between 40 and 60 years old were slightly lower than costs for patients 65 and older. Costs were also slightly higher for male patients with CODP than for female patients.
There were large differences in the costs of 30-day readmissions among patients by race and ethnicity. The lowest cost readmissions were for white patients while Asian and Pacific Islander patients were highest, costing between 32 and 38 percent more than white patients. Among readmissions where COPD was the principal diagnosis, the average readmission cost was $8,200 for a white patient compared to $11,300 for an Asian or Pacific Islander patient.
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