Ethnic disparities in the quality of hospital care in New Zealand, as measured by 30-day rate of unplanned readmission/death

Abstract

Objective. To compare the quality of hospital care for New Zealand (NZ) Maori and NZ European adult patients, using the rate of unplanned readmission or death within 30 days of discharge as an indicator of quality. Design. Retrospective cohort study. Setting. NZ public hospitals. Participants. Data from 89 658 patients who were admitted for one of a defined set of surgical procedures at NZ public hospitals 2002-8 were obtained from the NZ Ministry of Health. Outcome. The odds of readmission for NZ Maori when compared with NZ European patients were calculated using logistic regression, incorporating variables for age, sex, comorbidity, index procedure, hospital volume and socioeconomic position. Results. NZ Maori had 16% higher odds of readmission or death when compared with NZ European patients (OR = 1.16; 95% CI 1.08-1.24) after adjusting for all covariates. Readmission or death was also associated with being female (OR = 1.09; 1.03-1.15), older age (OR = 1.33; 1.19-1.48, for >79 years compared with 18-39 years), higher comorbidity (OR = 2.08; 1.89-2.31, for Charlson score 3+ compared with 0) and higher hospital volume (OR = 0.81; 0.76-0.86, for lowest volume compared with highest). Conclusions. This study suggests ethnic disparities in the quality of hospital care in NZ using unplanned readmission rate as an indicator of quality. There are well-documented differences in health outcomes between Maori and NZ Europeans, and it is possible that differential treatment within the health system contributes to these health status inequalities. © The Author 2013. Published by Oxford University Press in association with the International Society for Quality in Health Care; All rights reserved.