Post-Discharge Adverse Events Among African American and Caucasian Patients of an Urban Community Hospital



Patient safety during the post-discharge period is a major public health concern. Racial differences on incidence and risk factors associated with post-discharge adverse events (AEs) are understudied. The aim of the study was to examine the differences on the incidence of post-discharge AEs and the associated risk factors between African American and Caucasian patients.


This was a prospective cohort study of patients at risk for post-discharge AEs from December 2011 to October 2012. We included 589 patients who were African American or Caucasian and discharged home from an urban community hospital. The patients spoke English and could be contacted after discharge for evaluation. Two nurses performed 30-day post-discharge telephone interviews, and two physicians adjudicated health records to determine AEs using a previously established methodology.


African American patients had a slightly higher incidence of post-discharge AEs than Caucasian patients (30.6 vs. 29.9%), although the difference did not show statistical significance. The multivariable logistic regression model indicated that post-discharge AEs were associated with timely follow-up and the number of secondary discharge diagnoses. In subgroup analyses of the risk factors in each racial group separately, only timely follow-up ambulatory visits were associated with post-discharge AEs.


Post-discharge AEs were experienced by a large proportion of both African American and Caucasian patients, and there was no statistically significant difference in these proportions by race.

This is a preview of subscription content, log in to check access.


  1. 1.

    Tsilimingras D, Bates DW. Addressing postdischarge adverse events: a neglected area. Jt Comm J Qual Patient Saf. 2008;34(2):85–97.

    PubMed  Google Scholar 

  2. 2.

    Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161–7.

    Article  Google Scholar 

  3. 3.

    Dahya V, Bishop-Royse J. The sociodemographic characteristics of patients who experience postdischarge adverse events. J Geriatr Med Gerontol. 2018;4(2).

  4. 4.

    Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666–8.

    PubMed  PubMed Central  Google Scholar 

  5. 5.

    Hasnain-Wynia R. Disparities in health care are driven by where minority patients seek care: examination of the hospital quality alliance measures. Arch Intern Med. 1960;167(12):1233–9.

    Article  Google Scholar 

  6. 6.

    McClendon J, Bogdan R, Jackson JJ, Oltmanns TF. Mechanisms of Black-White disparities in health among older adults: examining discrimination and personality. J Health Psychol. 2019;1359105319860180.

  7. 7.

    Dovidio JF, Penner LA, Albrecht TL, Norton WE, Gaertner SL, Shelton JN. Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med. 2008;67(3):478–86.

    Article  Google Scholar 

  8. 8.

    Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404–16.

    CAS  Article  Google Scholar 

  9. 9.

    Pines JM, Mongelluzzo J, Hilton JA, Hollander JE, Shofer FS, Souder J, et al. Postdischarge adverse events for 1-day hospital admissions in older adults admitted from the emergency department. Ann Emerg Med. 2010;56(3):253–7.

    Article  Google Scholar 

  10. 10.

    Silverstein MD, Qin H, Mercer SQ, Fong J, Haydar Z. Risk factors for 30-day hospital readmission in patients >/=65 years of age. Proc (Baylor Univ Med Cent). 2008;21(4):363–72.

    Article  Google Scholar 

  11. 11.

    Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;215(3):322–30.

    Article  Google Scholar 

  12. 12.

    Coffey RM, Andrews RM, Moy E. Racial, ethnic, and socioeconomic disparities in estimates of AHRQ patient safety indicators. Med Care. 2005;43(3 Suppl):I48–57.

    PubMed  Google Scholar 

  13. 13.

    Priority Populations. 2019; Accessed 14 May 2020.

  14. 14.

    Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974;9(3):208–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Tsilimingras D, Schnipper J, Duke A, Agens J, Quintero S, Bellamy G, et al. Post-discharge adverse events among urban and rural patients of an urban community hospital: a prospective cohort study. J Gen Intern Med. 2015;30(8):1164–71.

    Article  Google Scholar 

  16. 16.

    Schnipper JL, Roumie CL, Cawthon C, Businger A, Dalal AK, Mugalla I, et al. Rationale and design of the pharmacist intervention for low literacy in cardiovascular disease (PILL-CVD) study. Circ Cardiovasc Qual Outcomes. 2010;3(2):212–9.

    Article  Google Scholar 

  17. 17.

    Parry C, Mahoney E, Chalmers SA, Coleman EA. Assessing the quality of transitional care: further applications of the care transitions measure. Med Care. 2008;46(3):317–22.

    Article  Google Scholar 

  18. 18.

    Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170(3):345–9.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5):565–71.

    Article  Google Scholar 

  20. 20.

    Kripalani S, Roumie CL, Dalal AK, et al. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012;157(1):1–10.

    Article  Google Scholar 

  21. 21.

    Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324(6):377–84.

    CAS  Article  Google Scholar 

  22. 22.

    Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, Williams EJ, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. 2000;38(3):261–71.

    CAS  Article  Google Scholar 

  23. 23.

    Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. N Engl J Med. 1991;324(6):370–6.

    CAS  Article  Google Scholar 

  24. 24.

    Fox-Wasylyshyn SM, El-Masri MM. Handling missing data in self-report measures. Res Nurs Health. 2005;28(6):488–95.

    Article  Google Scholar 

  25. 25.

    Tsilimingras D, Ghosh S, Duke A, Zhang L, Carretta H, Schnipper J. The association of post-discharge adverse events with timely follow-up visits after hospital discharge. PLoS One. 2017;12(8):e0182669.

    Article  Google Scholar 

  26. 26.

    Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94:2084–90.

    Article  Google Scholar 

Download references


This work is supported by an R01 award from the Agency for Healthcare Research and Quality (grant R01HS018694 to Dr. Tsilimingras).

Author information



Corresponding author

Correspondence to Dennis Tsilimingras.

Ethics declarations


The content is solely the responsibility of the authors and does not necessarily represent the official views of the agency for healthcare research and quality.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Costello, W.G., Zhang, L., Schnipper, J. et al. Post-Discharge Adverse Events Among African American and Caucasian Patients of an Urban Community Hospital. J. Racial and Ethnic Health Disparities (2020).

Download citation


  • Health disparity
  • Transitional care
  • Patient safety
  • Race