Nav: Home

Disparities in postop readmission may be reduced by improving nurse-to-patient staffing

October 31, 2016

PHILADELPHIA, PA (October 31, 2016) - A new study from the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research (CHOPR) shows that older black adults are not only more likely to be readmitted following an elective hip/knee replacement, than otherwise similar white patients - they may also be more adversely affected by insufficient hospital nurse staffing. The results are set for publication in a future issue of the Journal of the American Geriatric Society, but are available now online here. The cross-sectional study analyzed data of nearly 107,000 Medicare patients in 483 US hospitals and points to improving nurse-to-patient staffing ratios as a strategy for reducing racial disparities in postoperative readmissions.

After accounting for patient factors such as patient acuity, age, and socioeconomic status, as well as characteristics of the hospital where patients receive care, older black adults have a 30 percent increased likelihood of readmission compared with their white counterparts. "Patients have multiple risk factors, such as older age or comorbidity, which predispose them to re-hospitalization. Our findings suggest that an individual's race is one such risk factor for poorer health outcomes," says the study's lead investigator Karen Lasater PhD, RN, and a Postdoctoral Fellow at CHOPR. Racial disparities in readmission outcomes are widely recognized and remain unabated despite numerous efforts in the public and private sectors.

The study points to hospital nurse staffing as a likely mechanism for reducing readmissions in this postsurgical group and further demonstrates the added value for older minority adults. Every additional patient in a nurse's workload was associated with eight percent increased odds of readmission among older white patients and 15 percent increased odds among older black patients.

"What is striking about these findings is that we find this relationship even in a cohort of relatively healthy adults undergoing an elective surgery. The protective benefit of higher nurse-to-patient staffing for minorities may be related to gaps in health care access, financial flexibility, and social support systems. If individuals lack resources to mobilize ongoing support following discharge, the quality and intensity of care received during the hospitalization may help to address such gaps," says Lasater.

Since 2010, hospitals have been financially penalized for high readmission rates under the Centers for Medicare and Medicaid Services Hospital Readmission Reduction Program. Safety-net hospitals, those serving a disproportionate share of low-income and under-served patients, are more likely to experience financial penalties and have demonstrated slower improvements in curbing readmission rates overtime, compared to better resourced hospitals. These study findings provide insight into one potential mechanism that may help alleviate readmission disparities observed across various patient populations.

This study shows nurse staffing is important for the health outcomes of all patients, but may have a more protective effect for black patients. While the study does not demonstrate causation, it suggests a focus on supporting front line providers can improve readmissions for high-risk groups.
-end-
Matthew McHugh, PhD, JD, MPH, RN, Associate Director of CHOPR, served as co-lead investigator for this research. This study was supported by grants from the National Institute of Nursing Research (R01-NR04513, T32-NR0714 and R01-AG041099-01), and from the Robert Wood Johnson Foundation Nurse Faculty Scholars Program.

About the University of Pennsylvania School of Nursing

The University of Pennsylvania School of Nursing is one of the world's leading schools of nursing, is consistently ranked as one of the top graduate nursing schools in the United States, and is among the nation's top recipients of nursing research funding from the National Institutes of Health. Penn Nursing prepares nurse scientists and nurse leaders to meet the health needs of a global society through research, education, and practice. Follow Penn Nursing on: Facebook, Twitter, LinkedIn, Instagram & YouTube.

University of Pennsylvania School of Nursing

Related Medicare Articles:

Study: Medicare could overpay medicare advantage plans by $200 billion over ten years
Research conducted at University of California San Diego School of Medicine found that current trends in diagnostic coding for patient risk scores will lead to Medicare overpaying Medicare Advantage (MA) plans substantially through 2026-likely to the tune of hundreds of billions of dollars.
10,000 Medicare patients die in the seven days after discharge from the ED
Researchers found that, each year, about 10,000 generally healthy patients die in the seven days after discharge from the ED.
Hospitals in Medicare ACOs reduced readmissions faster
The Accountable Care Organization model of paying for health care appears to help reduce hospital readmissions among Medicare patients discharged to skilled nursing facilities, a new study suggests.
Highest out-of-pocket cancer spending for Medicare patients without supplement
Which Medicare beneficiaries shoulder the highest out-of-pocket costs after a cancer diagnosis?
Medicare's new way of paying hospitals could cause a bundle of problems for some
Hospitals that take care of the oldest, sickest and most complicated patients could suffer financially under the Medicare system's new approach to paying for some types of care, a new study finds.
Study examines opioid agonist therapy use in Medicare patients
Few Medicare enrollees appear to be receiving buprenorphine-naloxone, the only opioid agonist therapy for opioid addiction available through Medicare Part D prescription drug coverage, according to a study published online by JAMA Psychiatry.
Possible to account for disadvantaged populations in Medicare's payment programs
A new report from the National Academies of Sciences, Engineering, and Medicine says that Medicare's value-based payment programs could take into account social risk factors -- such as low socio-economic position, residence in disadvantaged neighborhoods, or race and ethnicity -- but any proposal to do so will entail both advantages and disadvantages that need to be carefully considered.
The association between Medicare eligibility and rehabilitative care
Researchers from the Center for Surgery and Public Health at BWH found that becoming Medicare eligible at age 65 (as compared to age 64) was associated with an abrupt 6.4 percentage-point decline in the number of people who were uninsured and a 9.6 percentage-point increase in rehabilitation.
Telemedicine use increases among rural Medicare beneficiaries
Telemedicine use in Medicare has been increasing rapidly, and in 2013 there were over 100,000 telemedicine visits for Medicare beneficiaries.
Study examines use of telemedicine among rural medicare beneficiaries
Although the number of Medicare telemedicine visits increased more than 25 percent a year for the past decade, in 2013, less than 1 percent of rural Medicare beneficiaries received a telemedicine visit, according to a study appearing in the May 10, 2016 issue of JAMA.

Related Medicare Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Bias And Perception
How does bias distort our thinking, our listening, our beliefs... and even our search results? How can we fight it? This hour, TED speakers explore ideas about the unconscious biases that shape us. Guests include writer and broadcaster Yassmin Abdel-Magied, climatologist J. Marshall Shepherd, journalist Andreas Ekström, and experimental psychologist Tony Salvador.
Now Playing: Science for the People

#513 Dinosaur Tails
This week: dinosaurs! We're discussing dinosaur tails, bipedalism, paleontology public outreach, dinosaur MOOCs, and other neat dinosaur related things with Dr. Scott Persons from the University of Alberta, who is also the author of the book "Dinosaurs of the Alberta Badlands".