IMPACT OF SOCIOECONOMIC STATUS ON HOSPITAL READMISSION AND HEALTHCARE ACCESS IN URBAN HISPANIC COMMUNITIES

Aram A Namavar, MS*1,2;Niraj Asthana, BS1;Christopher Soriano, BS1;Nasim Afsarmanesh, M.D., S.F.H.M.1;Ashley Busuttil, MD1;Sitaram Vangala, MS1 and Erin Paz Dowling, MD1, (1)University of California-Los Angeles, David Geffen School of Medicine, Los Angeles, CA, (2)Loyola University Chicago - Stritch School of Medicine, Maywood, IL

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 196

Categories: Quality Improvement, Research Abstracts

Keywords: , , ,

Background: It has been detailed in the literature that a patient’s socioeconomic status (SES) may play a role in their risk of readmission for specific diseases. For instance, factors such as low income, low educational level, and Medicaid status have all been associated with significantly higher rates of readmission in patients initially admitted for congestive heart failure, severe sepsis, and total hip arthroplasty. Despite this research, there are still gaps that need to be elucidated. Our study, aims to further add to the literature on SES and readmissions and specifically fill the gap on race, language, patient perspective on future readmission, and self-reported health status.

Methods: Discharge data was obtained via the electronic health record for the general medicine service line at the study sites. Patients being discharged within 48 hours to home or home health were included for enrollment in our study. Patients were then screened for exclusion criteria including: patient unwilling to participate, or patient placed under droplet or airborne precautions. Continuous variables were compared using the student t-test. Categorical variables were compared using chi-squared analysis.

Results: 259 patients were successfully interviewed.  67 patients self-identified as Hispanic and 192 patients self-identified as Non-Hispanic. All data were statistically significant (P<0.05) unless otherwise noted. Hispanic patients were younger and had a lower level of education. Less Hispanic patients were employed for salary 4.5% vs. 14.6%, more Hispanic patients were out of work and not currently looking for work 9% vs 3.1% (P = 0.084), and less Hispanic patients were retired 29.9% vs. 42.7% (P = 0.087). Furthermore, Hispanic patients lived in larger households. Logistically, more Non-Hispanic patients stated that they have access to transportation to pick up medication post-discharge, 77.6% vs. 89.1%. Less Hispanic patients stated they had a Primary Care Physician or main doctor that they felt comfortable if they started to feel worse at home: 83.6% vs. 93.2%. Of note, Hispanic patients rated their overall health higher, viewed their doctor’s rating of their overall health higher, while stating they were more likely to be readmitted again. The socioeconomic factor that was significantly associated with readmissions was being employed for salary. Finally, Hispanic patients were found to be at a significantly higher risk of 30-day readmission, as evidenced by their higher LACE scores. However, despite having higher LACE scores, Hispanic patients were readmitted at a similar rate to non-Hispanic patients, 18.8% vs. 20.3%.

Conclusions: Our results indicate socioeconomic disparities between Hispanic and non-Hispanic patients. First, Hispanic patients were found to have less economic stability outside the hospital (less likely to be employed for salary, less educational attainment, larger households). Hispanic patients had greater limitations to healthcare access (less access to transportation for medication pick-up, fewer have PCPs). Moreover, despite being significantly younger upon admission, Hispanic patients had a significantly higher risk of 30-day readmission, evidenced by their higher LACE scores. Despite all these factors, there was no significant difference in 30-day readmission rate between Hispanic and non-Hispanic patients. This finding could be explained by a number of factors, namely as demonstrated in our data being the greater limitations to healthcare access faced by Hispanic patients.

To cite this abstract:

Namavar, AA; Asthana, N; Soriano, C; Afsarmanesh, N; Busuttil, A; Vangala, S; Dowling, EP . IMPACT OF SOCIOECONOMIC STATUS ON HOSPITAL READMISSION AND HEALTHCARE ACCESS IN URBAN HISPANIC COMMUNITIES. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 196. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/impact-of-socioeconomic-status-on-hospital-readmission-and-healthcare-access-in-urban-hispanic-communities/. Accessed November 20, 2019.

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