Document Detail

Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia.
MedLine Citation:
PMID:  23151591     Owner:  NLM     Status:  MEDLINE    
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.
Matthew D McHugh; Chenjuan Ma
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Medical care     Volume:  51     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-11     Completed Date:  2013-02-20     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  52-9     Citation Subset:  IM    
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MeSH Terms
Age Factors
Aged, 80 and over
Clinical Nursing Research
Education, Nursing / statistics & numerical data
Heart Failure / epidemiology,  nursing*
Hospitals / manpower,  statistics & numerical data
Length of Stay
Medicare / statistics & numerical data
Myocardial Infarction / epidemiology,  nursing*
Nursing Staff, Hospital / organization & administration*,  statistics & numerical data
Patient Readmission / statistics & numerical data*
Personnel Staffing and Scheduling / organization & administration,  statistics & numerical data
Pneumonia / epidemiology,  nursing*
Quality of Health Care / organization & administration,  statistics & numerical data
Sex Factors
United States
Workload / statistics & numerical data
Grant Support
P30 NR005043/NR/NINR NIH HHS; P30-NR-005043/NR/NINR NIH HHS; R01 AG041099/AG/NIA NIH HHS; R01 NR004513/NR/NINR NIH HHS; R01-NR-004513/NR/NINR NIH HHS; R01AG041099-01/AG/NIA NIH HHS
Republished in:
J Nurs Adm. 2013 Oct;43(10 Suppl):S11-8   [PMID:  24022077 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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