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:

How common is food insecurity among Medicare enrollees? 
Nearly 1 in 10 Medicare enrollees age 65 and over and 4 in 10 enrollees younger than 65 with long-term disabilities experience food insecurity.
Medicare for All unlikely to cause surge in hospital use: Harvard study
Despite some analysts' claims that Medicare for All would cause a sharp increase in health care utilization, a new study finds the two biggest coverage expansions in US history -- Medicare and the ACA -- caused no net increase in hospital use.
Critical heart drug too pricey for some Medicare patients
An effective drug to treat chronic heart failure may cost too much for senior citizens with a standard Medicare Part D drug plan, said a study co-authored by a John A.
Research suggests strategy for more equitable Medicare reimbursement
Those who were enrolled in both Medicare and Medicaid were sicker, had more cognitive impairments and difficulty functioning, and needed more social support than those who were not enrolled in both government programs, Saint Louis University research found.
BU finds Medicare Advantage networks are broad and getting broader
A new study led by Boston University School of Public Health (BUSPH) researchers finds that networks in Medicare Advantage -- a private plan alternative to traditional Medicare -- are relatively broad and may be getting broader.
A viable alternative to Medicare-for-all? We can and must do better!
Medicare-for-all, a solution that would bring United States healthcare policies more in line with other industrial nations, faces strong opposition and is unlikely to be enacted in the foreseeable future.
Researchers teach 'machines' to detect Medicare fraud
Like a 'needle in a haystack,' human auditors have the painstaking task of manually checking thousands of Medicare claims for specific patterns that could indicate foul play or fraudulent behaviors.
Overall well-being of a population associated with less per capita medicare spending
A new study in JAMA Network Open finds that the overall well-being of a population on a county level is associated with lower healthcare spending for each Medicare fee-for-service beneficiary.
Study estimates eyeglass use by Medicare patients
Traditional Medicare doesn't cover eyeglasses except after cataract surgery and changing the policy has been discussed.
The rising price of Medicare Part D's 10 most costly medications
Researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego have found that the cost for the 10 'highest spend' medications in Medicare Part D -- the US federal government's primary prescription drug benefit for older citizens -- rose almost one-third between 2011 and 2015, even as the number of persons using these drugs dropped by the same amount.
More Medicare News and Medicare Current Events

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

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.