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Ethnic disparities in readmission rates and excess length of hospital stay. A nationwide record linked retrospective cohort study. Martine C. de Bruijne 1 Ellen Uiters 2 Mariël Droomers 2 J. Suurmond 3 M.L. Essink-Bot 3 K. Stronks 3 1. EMGO+ , Institute for Health and Care Research, VU University Medical Centre (VUmc), Department of Public and Occupational Health, Amsterdam, The Netherlands 2. Department of Public Health and Healthcare, National Institute for Public Health and the Environment, Bilthoven, The Netherlands 3. Department of Social Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands Correspondence to: Martine C. de Bruijne EMGO+ Institute for Health and Care Research VU University Medical Centre (VUmc) Department of Public and Occupational Health, Office C-570 Van der Boechorststraat 7 1081 BT Amsterdam The Netherlands Telephone: +31 20 4448166 Email: mc.debruyne@vumc.nl Word count: xxxx (main text) and xxx (abstract) 34
ABSTRACT Introduction Increasingly, studies have found ethnic disparities in quality of care. Little is known about ethnic disparities in patient safety, the minimum prerequisite for good quality of care. We aimed to explore ethnic disparities in readmission rates and excess length of hospital (LOS) stay to get an indication of potential differences in patient safety. Method We constructed a cohort of all admissions to Dutch hospitals (1995-2005) by linking information from 3 national databases to study readmissions within 30 days after discharge and excess LOS. Multivariable and multilevel analyses were applied to assess variation in both outcomes across migrant groups while adjusting stepwise for demographics, patient-mix and socio-economic indicators. Results Overall, migrant groups had higher rates of readmissions and excess LOS after controlling for demographics and patient mix. The largest risks were observed among older patients and in Surinamese and Antillean patients. These disparities were partly but not largely accounted for by socio-economic indicators. Conclusions Migrant groups seem to be systematically at a disadvantage when it comes to readmission rates and excess LOS. Future research is needed to explain patient and health-care related mechanisms underlying these results and to facilitate the development of targeted interventions. Introduction Patient safety has worldwide been recognised as an important health care challenge. Patient safety forms the minimum prerequisite of good quality of care. This equally applies to all patients, independent of their ethnic background. Record review studies in several countries have shown that a substantial number of hospitalised patients experience adverse events (AEs), defined as unintended injuries caused by the medical management, which may even result in the patients’ death. Approximately half of the AEs were judged to be preventable (1-11). Causes have mainly been sought in technical, organisational and human factors in the delivery of health care (12-13). Based on these findings, patient safety interventions are being implemented in hospitals and national patient safety programmes are initiated to reduce the amount of AEs. Until now, little is known about disparities in patient safety between ethnic groups. A few studies in the US indicated an adverse position of ethnic groups in the occurrence of specific adverse events (14-18). For example, Chang et al (17) found that black patients were approximately 20% more likely to experience some AEs, but were less likely to experience other AEs. Flores & Ngui (15) performed a systematic review and found ethnic disparities in specific pediatric adverse events such as higher rates of newborn birth trauma and infections attributable to medical care. It is largely unknown whether these ethnic patient safety disparities are related to specific diagnostic or therapeutic groups or whether they are representative for ethnic disparities in a broad range of medical care. Insight in patient safety patterns across a broad range of health care may provide clues of mechanisms underlying ethnic disparities in patient safety. In addition, it will enable the identification of ethnic patient groups at increased risk and the development targeted patient safety interventions. Record review studies have shown that AEs during hospitalisation often result in readmissions and extra bed-days (2, 19-22). Unpublished analyses from the Dutch study 35
Page 1 and 2: Etnische en sociaaleconomische vers
Page 3: Inhoudsopgave 1. Samenvatting 5 2.
Page 6 and 7: Wanneer de autochtone en de allocht
Page 8 and 9: Gelet op de groeiende omvang van de
Page 10 and 11: statistische modellen te corrigeren
Page 12 and 13: De analyses zijn gedaan zonder reke
Page 15 and 16: 4 Resultaten 4.1 Zijn er verschille
Page 17 and 18: Tabel 4.2. Verschil in verlengde li
Page 19 and 20: Tabel 4.3. Verschil in klinische he
Page 21 and 22: 2. Het risico op incidenten kan gro
Page 23 and 24: - A minimum mean number of secondar
Page 25: 1. Voorkómen van onbedoelde vermij
Page 28 and 29: Voorts konden wij in de analyses va
Page 30 and 31: Raad voor GezondheidsOnderzoek. Van
Page 33: Bijlage 1 Ethnic disparities in rea
Page 37 and 38: neighbourhoods, the HDR provided in
Page 39 and 40: The risk of excess LOS of at least
Page 41 and 42: within each migrant group this was
Page 43 and 44: 22. Rivard PE, Luther SL, Christian
Page 45 and 46: Table 1. Characteristics of hospita
Page 47 and 48: Operations on the eye Other miscell
Page 49 and 50: capillaries Diseases of the respira
Page 51 and 52: Bijlage 2 Explaining ethnic dispari
Page 53 and 54: A few studies indicate that languag
Page 55 and 56: said they had the option of using a
Page 57 and 58: complaining, and three days after t
Page 59 and 60: 19. Miles MB, Huberman AM. Qualitat
Page 61 and 62: Appendix 1 Case Ethnicity (as defin
Page 63: 22 Somali Female Because of nausea,
Page 66 and 67: Tabel A3-1. Verschil in klinische h
Page 68 and 69: Tabel A3-3. Verschil in verlengde l

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