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Quality Update - Health care quality issues for Minnesota's health care leaders

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Looking at the numbers: Disparities in Minnesota Hospital Readmission Rates

Figure 1.

Readmission Rates for Medicare FFS Consumers
Rolling four quarters.

Figure 2.

Readmission Rates for Medicare FFS Consumers by Race/Ethnicity

Reducing hospitalizations has long been a focus area for national and local health care quality improvement efforts. When data from the Centers for Medicare & Medicaid Services (CMS) revealed uneven quality performance across the country, it signaled opportunities for improved care and reduced cost. Much has evolved since CMS first focused on inappropriate hospital admissions in the 1980s. Today, CMS continues its focus on reducing hospitalizations, with attention and incentives to drive down readmissions.

Health care organizations monitor readmissions using numerous methods such as 30-day readmissions overall, as well as readmissions for people discharged to nursing homes or home health agencies, Medicare fee-for-service (FFS) risk-adjusted 30-day readmissions, potentially preventable readmissions (PPRs), and admissions for ambulatory care sensitive conditions, like diabetes and heart failure.

Minnesota remains better than the nation for 30-day unadjusted readmission rates for Medicare FFS beneficiaries, looking at rolling four quarters from fourth quarter (4Q) 2013 through third quarter (3Q) 2017 (Figure 1). Overall Minnesota performs almost a percentage point better than the nation in this most recent data, with readmissions at 17.6 percent for Minnesota compared to 18.4 percent for the nation. In this four year period, national rates have trended down slightly while Minnesota has trended up by a similar margin.

Data stratified through an equity lens

Looked at through a health equity lens, Minnesota's readmissions data stratified by race and ethnicity shows uneven quality performance, signaling opportunities for improved care and reduced cost (Figure 2).

Disparities within Minnesota

In Minnesota, Medicare FFS beneficiaries who identify as being part of a diverse population have notably higher rates of readmissions, compared to the majority white population. The most recent Medicare data available, fourth quarter (4Q) 2016 through third quarter (3Q) 2017, shows the following Minnesota disparities in readmissions rates, compared to whites:

  • 1.8 percent worse for Hispanics
  • 3.3 percent worse for Asians
  • 9.7 percent worse for Blacks
  • 9.7 percent worse for North American Natives

Minnesota worse than the nation

Our readmissions disparities story deepens when Minnesota populations are compared to the nation. Minnesota's Hispanic population fares better than Hispanics nationwide, although still performing worse than Minnesota's white population. While white Minnesotans fare somewhat better than the white population nationally, our Asian, Black, and North American Native populations fare worse than their national counterparts.

  • 1.7 percent worse for Asians
  • 3.2 percent worse for Blacks
  • 6.0 percent worse for North American Natives

Data to drive improvement

Health care organizations need to stratify their own readmissions data to uncover disparities masked in overall averages. Armed with that data, discussions about interventions can take a more targeted approach to meet the specific needs and circumstances of adversely affected populations to improve the quality of care for all Minnesotans.

Source for both charts: Medicare fee-for-service (FFS) 30-day readmission rates, most recent data available. Not risk adjusted. Note: Lower rates are better.