30-Day Potentially Preventable Inpatient Readmissions for Native Hawaiians and Asian Subgroups

Objective: Preventable readmissions are an important metric of health care quality and the focus of current national initiatives. Limited data exist regarding preventable readmissions for Asian and Pacific Islander subgroups. 

Study Design: Detailed discharge data from all hospitalizations in Hawaii from 2007-2012 were analyzed for Native Hawaiians, whites, Japanese, Filipinos, Chinese, and other Pacific Islanders 18 years and older (n= 495,910). Potentially preventable readmissions were identified using 3M Potentially Preventable Readmission (PPR) methodology and compared by race/ethnicity in multivariable models controlling for insurance, age group, gender, substance use, comorbidity, and race, gender, age group interactions.

Results: The sample was 29.4% white, 17.4% Native Hawaiian, 18.9% Japanese, 12.9% Filipino, 4.1% Chinese, 5.2% other Pacific Islander, and 12.0% other race. Eight percent (39,702 hospitalizations) by 24,847 individuals were identified as potentially avoidable readmissions.

Demographic differences were seen across racial/ethnic groups in preventable readmissions. Notably, 72.5% of other Pacific Islanders and 60% of Native Hawaiians were under 65, compared to 22.6% of Chinese and 20.7% of Japanese. In multivariable models, Filipino, other Pacific Islander, and Native Hawaiian men and women over 65 were significantly more likely to have a potentially preventable readmission than whites, as were Native Hawaiian men under 65.

Conclusions: Older Filipinos, other Pacific Islanders, and Native Hawaiians were significantly more likely to have a potentially preventable readmission than whites as were working-age Native Hawaiian men. These findings suggest that a patient’s race/ethnicity is a determinant of hospital readmission. Further study is needed to understand the reasons for these disparities, which might include social and economic factors as well as access and quality of care.