Abstract
Background
Patient safety during the post-discharge period is a major public health concern. Racial differences on incidence and risk factors associated with post-discharge adverse events (AEs) are understudied. The aim of the study was to examine the differences on the incidence of post-discharge AEs and the associated risk factors between African American and Caucasian patients.
Methods
This was a prospective cohort study of patients at risk for post-discharge AEs from December 2011 to October 2012. We included 589 patients who were African American or Caucasian and discharged home from an urban community hospital. The patients spoke English and could be contacted after discharge for evaluation. Two nurses performed 30-day post-discharge telephone interviews, and two physicians adjudicated health records to determine AEs using a previously established methodology.
Results
African American patients had a slightly higher incidence of post-discharge AEs than Caucasian patients (30.6 vs. 29.9%), although the difference did not show statistical significance. The multivariable logistic regression model indicated that post-discharge AEs were associated with timely follow-up and the number of secondary discharge diagnoses. In subgroup analyses of the risk factors in each racial group separately, only timely follow-up ambulatory visits were associated with post-discharge AEs.
Conclusion
Post-discharge AEs were experienced by a large proportion of both African American and Caucasian patients, and there was no statistically significant difference in these proportions by race.
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References
Tsilimingras D, Bates DW. Addressing postdischarge adverse events: a neglected area. Jt Comm J Qual Patient Saf. 2008;34(2):85–97.
Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161–7.
Dahya V, Bishop-Royse J. The sociodemographic characteristics of patients who experience postdischarge adverse events. J Geriatr Med Gerontol. 2018;4(2).
Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666–8.
Hasnain-Wynia R. Disparities in health care are driven by where minority patients seek care: examination of the hospital quality alliance measures. Arch Intern Med. 1960;167(12):1233–9.
McClendon J, Bogdan R, Jackson JJ, Oltmanns TF. Mechanisms of Black-White disparities in health among older adults: examining discrimination and personality. J Health Psychol. 2019;1359105319860180.
Dovidio JF, Penner LA, Albrecht TL, Norton WE, Gaertner SL, Shelton JN. Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med. 2008;67(3):478–86.
Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404–16.
Pines JM, Mongelluzzo J, Hilton JA, Hollander JE, Shofer FS, Souder J, et al. Postdischarge adverse events for 1-day hospital admissions in older adults admitted from the emergency department. Ann Emerg Med. 2010;56(3):253–7.
Silverstein MD, Qin H, Mercer SQ, Fong J, Haydar Z. Risk factors for 30-day hospital readmission in patients >/=65 years of age. Proc (Baylor Univ Med Cent). 2008;21(4):363–72.
Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;215(3):322–30.
Coffey RM, Andrews RM, Moy E. Racial, ethnic, and socioeconomic disparities in estimates of AHRQ patient safety indicators. Med Care. 2005;43(3 Suppl):I48–57.
Priority Populations. 2019; https://www.ahrq.gov/topics/priority-populations/index.html. Accessed 14 May 2020.
Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974;9(3):208–20.
Tsilimingras D, Schnipper J, Duke A, Agens J, Quintero S, Bellamy G, et al. Post-discharge adverse events among urban and rural patients of an urban community hospital: a prospective cohort study. J Gen Intern Med. 2015;30(8):1164–71.
Schnipper JL, Roumie CL, Cawthon C, Businger A, Dalal AK, Mugalla I, et al. Rationale and design of the pharmacist intervention for low literacy in cardiovascular disease (PILL-CVD) study. Circ Cardiovasc Qual Outcomes. 2010;3(2):212–9.
Parry C, Mahoney E, Chalmers SA, Coleman EA. Assessing the quality of transitional care: further applications of the care transitions measure. Med Care. 2008;46(3):317–22.
Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170(3):345–9.
Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5):565–71.
Kripalani S, Roumie CL, Dalal AK, et al. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012;157(1):1–10.
Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324(6):377–84.
Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, Williams EJ, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. 2000;38(3):261–71.
Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. N Engl J Med. 1991;324(6):370–6.
Fox-Wasylyshyn SM, El-Masri MM. Handling missing data in self-report measures. Res Nurs Health. 2005;28(6):488–95.
Tsilimingras D, Ghosh S, Duke A, Zhang L, Carretta H, Schnipper J. The association of post-discharge adverse events with timely follow-up visits after hospital discharge. PLoS One. 2017;12(8):e0182669.
Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94:2084–90.
Funding
This work is supported by an R01 award from the Agency for Healthcare Research and Quality (grant R01HS018694 to Dr. Tsilimingras).
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Costello, W.G., Zhang, L., Schnipper, J. et al. Post-Discharge Adverse Events Among African American and Caucasian Patients of an Urban Community Hospital. J. Racial and Ethnic Health Disparities 8, 439–447 (2021). https://doi.org/10.1007/s40615-020-00800-z
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DOI: https://doi.org/10.1007/s40615-020-00800-z