WISCONSIN — Black hospitalized patients are less likely to get a referral for home health care in comparison to white peers, according to a recent study from the University of Michigan and Marquette University. 

Researchers found that about 22% of Black patients are referred to home health care by discharge nurses, compared to 27% of white patients. To conduct this study, researchers examined discharge records from 14,684 Medicare patients in 31 hospitals around the nation.

However, Black patients have statistically higher risk factors for hospital readmission, per the study. Those risk factors include comparatively higher rates of living alone, being unmarried and having more chronic health conditions. Researchers noted that Black patients had the highest readmission rate at 15%. White patients had a 10% readmission rate, while Hispanic patients had a 13% readmission rate.

Per the study, Black patients were “routinely rated equally ready for hospital discharge as white patients.” Black patients were rated higher than Hispanic patients and patients of other ethnicities. Researchers said that this means Black patients would only get the same offs of a home care referral if they were “considerably less ready to go home [from the hospital]” in comparison to their white peers.

When utilizing a 10-point scale to measure readiness for discharge, researchers found that differences in home health care referrals persisted for all patients who had a score of up to nine.

The study found that differences in home health referrals were highest for patients who scored six or lower on the 10-point scale, noting a 27% referral rate for Black patients compared to a 33% referral rate for white patients.

“All else being equal, Black patients must score two points higher on their discharge assessment to have an equal chance at a home health care referral as white patients,” a Marquette University press release about the study said.

Olga Yakusheva, the lead author of the study and a professor at the University of Michigan School of Public Health, said she found the disparities in referrals surprising.

“With Black patients, the difference in referral rates was observed against the combined backdrop of the elevated risk profile in addition to poor observed outcome of care,” she said. “So, for Black patients, the observed data are consistent with a potential failure of the health care system to provide appropriate care.”

Yakusheva noted the disparities seemed to impact Black patients more than Hispanic patients and other nonwhite patients.

Researchers admitted their data does not point to a concrete cause for these disparities. However, they did note that Black patients had less trust in the health care system, and were therefore more likely to decline home health care.

“Or, it could be structural bias. 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,” Yakusheva said.

She said she believes it is up to the health care system to address those issues.

“Interventions to build strong connections with minoritized groups in our communities and to build mutual trust and understanding between minoritized groups and health care professionals are needed to address systemic inequities in health care,” Yakusheva said.

“We as clinicians and researchers have to recognize and respect that patients and their families have essential knowledge that can inform interventions,” said co-author Abiola Keller, associate professor of nursing at Marquette University. “To effectively impact health disparities, we must authentically engage the communities most impacted in processes to co-create and implement potential solutions.”

Read the full study, here.