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Importance of Communication and Relationships: Addressing Disparities in Hospitalizations for African-American Patients in Academic Primary Care

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Abstract

Background

There are many interventions to facilitate seamless continuity of care for patients in transition from hospital back to primary care; however, disparities remain in readmission rates for vulnerable populations, especially African-Americans.

Objectives

We set out to investigate the association of race and ethnicity with 30-day readmission in our urban academic setting and to identify factors that could be leveraged in primary care to address disparities in hospitalizations.

Methods/Approach

Using data originally collected for quality improvement purposes, we evaluated 30-day readmission rates for our primary care patients (January 1, 2013–September 30, 2014) by race and ethnicity, adjusting for demographic and clinical characteristics. Then, using inductive and deductive methods, we coded semi-structured interviews with 24 African-American primary care patients who were discharged from the Medicine or Cardiology service at our tertiary care hospital during the study period.

Key Results

African-Americans had the highest readmission rate (21.7%) and a higher adjusted odds of readmission (1.37; 95% CI 1.04–1.81) compared to Whites. Five major themes emerged as having potential to be leveraged in primary care to help prevent multiple hospitalizations: (1) dependable patient-physician relationships, (2) healthcare coordination across settings, (3) continuity with one primary care provider (PCP), (4) disease self-management, and (5) trust in resident physicians. Participants also made several recommendations to keep patients like themselves from returning to the hospital: increased time to tell their story during their primary care visit, more direct patient-physician communication during the visit, and improved access between visits.

Conclusions

While African-American patients in our practice experience higher rates of hospital readmissions than their White counterparts, they emphasize the significance of their PCP relationship and communication to enhance disease management and prevent hospitalizations. Ongoing efforts are needed to establish and implement best practice communication trainings for patients at increased risk of hospitalization, particularly for resident physicians.

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Acknowledgments

Thank you to Jennifer Livaudais-Toman for her assistance with statistical programming.

Funding Information

This work was supported by a grant from the Mount Zion Health Fund.

Author information

Correspondence to Leah S. Karliner MD, MAS.

Ethics declarations

The institutional review board at the University of California San Francisco reviewed and granted an exemption for the study.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Valente, J., Johnson, N., Edu, U. et al. Importance of Communication and Relationships: Addressing Disparities in Hospitalizations for African-American Patients in Academic Primary Care. J GEN INTERN MED 35, 228–236 (2020). https://doi.org/10.1007/s11606-019-05392-x

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KEY WORDS

  • communication
  • health disparities
  • qualitative research
  • transitions of care
  • primary care interventions