Racial disparities in
readmission outcomes are widely recognized and remain unabated despite
numerous efforts in the public and private sectors.
A new study from the University of Pennsylvania School of Nursing's
Center for Health Outcomes and Policy Research (CHOPR) revealed 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
‘Every additional patient in a nurse's workload was associated with 8% increased odds of readmission among older white patients and 15% increased odds among older black patients.’
The results are set for publication in a future issue of the Journal of the American Geriatric Society
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%
increased likelihood of readmission compared with their white
"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 and a Postdoctoral Fellow at CHOPR.
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 8%
increased odds of readmission among older white patients and 15%
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