Importance of Communication and Relationships: Addressing Disparities in Hospitalizations for African-American Patients
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Division of General Internal Medicine, University of California San Francisco , San Francisco , CA , USA; 2Department of Health, Law, Policy and Management, Boston University School of Public Health , Boston , MA , USA; 3Department of Anthropology, University of California Davis , Davis , CA , USA; 4Multi-Ethnic Health Equity Research Center, Division of General Internal Medicine, University of California San Francisco , San Francisco , CA , USA.
BACKGROUND: There are many interventions to facilitate seamless continuity of care for patients in transition from hospital back to primary care; however, disparities remain in readmission rates for vulnerable populations, especially African-Americans. OBJECTIVES: We set out to investigate the association of race and ethnicity with 30-day readmission in our urban academic setting and to identify factors that could be leveraged in primary care to address disparities in hospitalizations. METHODS/APPROACH: Using data originally collected for quality improvement purposes, we evaluated 30-day readmission rates for our primary care patients (January 1, 2013–September 30, 2014) by race and ethnicity, adjusting for demographic and clinical characteristics. Then, using inductive and deductive methods, we coded semi-structured interviews with 24 African-American primary care patients who were discharged from the Medicine or Cardiology service at our tertiary care hospital during the study period. KEY RESULTS: African-Americans had the highest readmission rate (21.7%) and a higher adjusted odds of readmission (1.37; 95% CI 1.04–1.81) compared to Whites. Five major themes emerged as having potential to be leveraged in primary care to help prevent multiple hospitalizations: (1) dependable patient-physician relationships, (2) healthcare coordination across settings, (3) continuity with one primary care provider (PCP), (4) disease selfmanagement, and (5) trust in resident physicians. Participants also made several recommendations to keep patients like themselves from returning to the hospital: increased time to tell their story during their primary care visit, more direct patient-physician communication during the visit, and improved access between visits. CONCLUSIONS: While African-American patients in our practice experience higher rates of hospital readmissions Early findings from this manuscript were presented at the Society of General Internal Medicine annual meeting in 2017. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05392-x) contains supplementary material, which is available to authorized users. Received January 13, 2019 Revised July 16, 2019 Accepted September 10, 2019
than their White counterparts, they emphasize the significance of their PCP relationship and communication to enhance disease management and prevent hospitalizations. Ongoing efforts are needed to establish and implement best practice communication trainings for patients at increased risk of hospitalization, particularly for resident physicians. KEY W
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