Date of Award

2021

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Eileen V. Lake

Abstract

Comorbid mental health conditions (MHCs), which are common among pediatric patients, increase the risk of 30-day readmission and a longer length of stay (LOS). Despite the centrality of nurses in patient care, little attention has been focused on the contribution of nurses to improving the outcomes of patients with a comorbid MHC. The study’s first aim was to determine the association between the presence of a comorbid MHC and 30-day readmission and length of stay of pediatric medical and surgical patients, adjusting for patient and hospital characteristics. Its second aim was to compare the association of hospital nursing resources with 30-day readmission and length of stay in pediatric medical and surgical patients with and without a comorbid MHC after adjusting for patient and hospital characteristics.This study was a secondary analysis of 2014-2016 cross-sectional data from four states. The sample included 113,362 patients (medical: 71,170; surgical: 42,192) across 281 hospitals. In aim 1, we used random-effects logistic regression models to measure the association between the presence of a comorbid MHC and 30-day readmission, while zero-truncated negative binomial regression models were used for LOS. In aim 2, models included an interaction term between each hospital nursing resource and the presence of a comorbid MHC to test the moderating effect of hospital nursing resources on outcomes of medical and surgical patients with a comorbid MHC. After adjusting for patient and hospital characteristics, the presence of a comorbid MHC in medical and surgical patients was associated with higher odds of 30-day readmission and a higher relative risk of incurring an additional inpatient day. Hospital nursing resources moderated the relationship between a comorbid MHC and the odds of 30-day readmission in medical patients, but not surgical patients. However, hospital nursing resources did not moderate the relationship between a comorbid MHC and LOS in medical or surgical patients. Although a comorbid MHC increased a patient’s risk of 30-day readmission and LOS, better hospital nursing resources reduced the risk of readmission among medical patients with a comorbid MHC. Managers should consider improving hospital nursing resources to enhance the welfare of pediatric patients with a comorbid MHC.

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Available to all on Saturday, May 11, 2024

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