US hospitals that care for vulnerable populations
, “safety-net hospitals
” (SNHs), are more likely to incur penalties under the Hospital Readmissions
Reduction Program, which penalizes hospitals with higher-than-expected readmissions
. Understanding whether SNHs face unique barriers to reducing readmissions
or whether they underuse readmission-prevention strategies is important.
We surveyed leadership at 1600 US acute care hospitals, of whom 980 participated, between June 2013 and January 2014. Responses on 28 questions on readmission-related barriers and strategies were compared between SNHs and non-SNHs, adjusting for nonresponse and sampling strategy. We further compared responses between high-performing SNHs and low-performing SNHs.
We achieved a 62% response rate. SNHs were more likely to report patient-related barriers, including lack of transportation, homelessness, and language barriers compared with non-SNHs (P
-values<0.001). Despite reporting more barriers, SNHs were less likely to use e-tools to share discharge summaries (70.1% vs. 73.7%, P
<0.04) or verbally communicate (31.5% vs. 39.8%, P
<0.001) with outpatient providers, track readmissions
by race/ethnicity (23.9% vs. 28.6%, P
<0.001), or enroll patients in postdischarge programs (13.3% vs. 17.2%, P
<0.001). SNHs were also less likely to use discharge coordinators, pharmacists, and postdischarge programs. When we examined the use of strategies within SNHs, we found trends to suggest that high-performing SNHs were more likely to use several readmission strategies.
Despite reporting more barriers to reducing readmissions
, SNHs were less likely to use readmission-reduction strategies. This combination of higher barriers and lower use of strategies may explain why SNHs have higher rates of readmissions
and penalties under the Hospital Readmissions