Nurses are less likely to discharge still-recovering Black patients to home health care than white patients, a new study has found.
About 22% of Black patients are referred to home health care by discharge nurses, compared with 27% of white patients, according to a report published in the January issue of the journal Medical Care.
That's because discharge nurses routinely rate Black patients as ready for successful discharge, even though the patients are more likely to be unmarried, living alone and dealing with chronic conditions -- all risk factors that they'll wind up back in the hospital if they don't recover well at home.
Black patients have to be considerably less likely to have a successful discharge than white patients to have the same odds of getting a home care referral, researchers concluded.
Black patients often had an "elevated risk profile in addition to poor observed outcome of care," said lead researcher Olga Yakusheva, a professor with the University of Michigan School of Nursing and Public Health. That points to "a potential failure of the health care system to provide appropriate care," she said.
Home health care can help prevent hospital readmissions, by making sure the patient has the support they need to properly recover.
Hospitals assess a patient's odds for a successful recovery at home using a 10-point readiness for discharge assessment, researchers said. The higher the score, the less prepared a person is for discharge -- meaning they'll need extra assistance at home.
Examining discharge records from nearly 14,700 Medicare patients in 31 U.S. hospitals, the researchers found that Black patients needed to score two points higher on the discharge assessment to have an equal chance at a home health care referral as white patients.
The highest differences in home health referrals occurred in patients with discharge scores of 6 or lower, with 27% referral rates for Black patients versus 33% for white patients.
Meanwhile, Black patients had the highest hospital readmission rate at 15%, compared to 10% for white patients, 13% for Hispanic patients and 12% for other races.
"We as clinicians and researchers have to recognize and respect that patients and their families have essential knowledge that can inform interventions," said co-researcher Abiola Keller, an associate professor of nursing at Marquette University. Engaging with communities can bring about "potential solutions," she believes.
The study can't pinpoint the reason why Black patients are less likely to receive home health care, the researchers noted.
It could be because more Black patients turn down home health care because they have less trust in health care overall, Yakusheva said.
"Or, it could be structural bias,"Yakusheva added in a Michigan news release. "It is not that nurses are knowingly withholding care, but they may be sometimes miscommunicating or misunderstanding the needs of Black patients, including needs for in-home care after hospital discharge."
Whether the cause is patient mistrust or structural bias, the health care system needs to address this inequity, Yakusheva said.
More information
The Agency for Healthcare Research and Quality have more about hospital discharge assessment.
SOURCE: University of Michigan, news release, Dec. 7, 2023
