TY - JOUR
T1 - Hospital nursing and 30-day readmissions among medicare patients with heart failure, acute myocardial infarction, and pneumonia
AU - McHugh, Matthew D.
AU - Ma, Chenjuan
PY - 2013/10
Y1 - 2013/10
N2 - Background: Provisions of the Affordable Care Act that increase hospitals' financial accountability for preventable readmissions have heightened interest in identifying system-level interventions to reduce readmissions. Objectives: To determine the relationship between hospital nursing; that is, nurse work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Method and Design: Analysis of linked data from California, New Jersey, and Pennsylvania that included information on the organization of hospital nursing (ie, work environment, patient-to-nurse ratios, and proportion of nurses holding a BSN degree) from a survey of nurses, as well as patient discharge data, and American Hospital Association Annual Survey data. Robust logistic regression was used to estimate the relationship between nursing factors and 30-day readmission. Results: Nearly 1 quarter of heart failure index admissions [23.3% (n = 39,954)], 19.1% (n = 12,131) of myocardial infarction admissions, and 17.8% (n = 25,169) of pneumonia admissions were readmitted within 30 days. Each additional patient per nurse in the average nurse's workload was associated with a 7% higher odds of readmission for heart failure [odds ratio (OR) = 1.07; confidence interval CI, 1.05-1.09], 6% for pneumonia patients (OR = 1.06; CI, 1.03-1.09), and 9% for myocardial infarction patients (OR = 1.09; CI, 1.05-1.13). Care in a hospital with a good versus poor work environment was associated with odds of readmission that were 7% lower for heart failure (OR = 0.93; CI, 0.89-0.97), 6% lower for myocardial infarction (OR = 0.94; CI, 0.88-0.98), and 10% lower for pneumonia (OR = 0.90; CI, 0.85-0.96) patients. Conclusions: Improving nurses' work environments and staffing may be effective interventions for preventing readmissions.
AB - Background: Provisions of the Affordable Care Act that increase hospitals' financial accountability for preventable readmissions have heightened interest in identifying system-level interventions to reduce readmissions. Objectives: To determine the relationship between hospital nursing; that is, nurse work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Method and Design: Analysis of linked data from California, New Jersey, and Pennsylvania that included information on the organization of hospital nursing (ie, work environment, patient-to-nurse ratios, and proportion of nurses holding a BSN degree) from a survey of nurses, as well as patient discharge data, and American Hospital Association Annual Survey data. Robust logistic regression was used to estimate the relationship between nursing factors and 30-day readmission. Results: Nearly 1 quarter of heart failure index admissions [23.3% (n = 39,954)], 19.1% (n = 12,131) of myocardial infarction admissions, and 17.8% (n = 25,169) of pneumonia admissions were readmitted within 30 days. Each additional patient per nurse in the average nurse's workload was associated with a 7% higher odds of readmission for heart failure [odds ratio (OR) = 1.07; confidence interval CI, 1.05-1.09], 6% for pneumonia patients (OR = 1.06; CI, 1.03-1.09), and 9% for myocardial infarction patients (OR = 1.09; CI, 1.05-1.13). Care in a hospital with a good versus poor work environment was associated with odds of readmission that were 7% lower for heart failure (OR = 0.93; CI, 0.89-0.97), 6% lower for myocardial infarction (OR = 0.94; CI, 0.88-0.98), and 10% lower for pneumonia (OR = 0.90; CI, 0.85-0.96) patients. Conclusions: Improving nurses' work environments and staffing may be effective interventions for preventing readmissions.
KW - Nursing
KW - organizational culture
KW - quality of health care
KW - readmissions
KW - work environment
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U2 - 10.1097/01.NNA.0000435146.46961.d1
DO - 10.1097/01.NNA.0000435146.46961.d1
M3 - Article
C2 - 24022077
AN - SCOPUS:84884835933
SN - 0002-0443
VL - 43
SP - S11-S18
JO - Journal of Nursing Administration
JF - Journal of Nursing Administration
IS - 10 SUPPL.
ER -