The Effect Of Nursing Resources On Older Hispanic Surgical Patient Readmissions

Marguerite M. Daus, University of Pennsylvania

Abstract

THE EFFECT OF NURSING RESOURCES ON OLDER HISPANIC SURGICAL PATIENT READMISSIONS Marguerite M. Daus J. Margo Brooks Carthon As the U.S. Hispanic population has grown, so have health disparities, including hospital readmissions after common surgical procedures among older adults. One potential explanation is that Hispanic patients may receive care in hospitals with lower quality nursing care. This study advances disparities research by evaluating the relationship between nursing resources and hospital readmissions among older Hispanic patients using multiple data sources from 2014-2016. We hypothesized that older (65+) Hispanic surgical patients will have lower odds of readmission through 90 days if cared for in hospitals with better nursing resources (i.e., lower patient-to-nurse ratios and higher work environment scores). The sample included 522 hospitals and 732,035 general, orthopedic, and vascular surgery patients (80,978 Hispanic patients and 651,057 non-Hispanic White patients) located in 4 states (CA, FL, NJ, PA). Multivariable logistic regression models with interaction terms were fit to determine the relationship between hospital-level nursing resources and Hispanic patient readmission at multiple time periods (7-, 14-, 30-, and 90-days). After adjusting for patient and hospital characteristics, older Hispanic surgical patients had 6-11% higher odds of readmission compared to non-Hispanic White patients. Significant interactions were found between ethnicity and nursing resources. Hispanic patients (OR=1.05, p=0.001) experienced higher odds of readmission for each additional patient in the average nurse's workload compared to non-Hispanic White patients at 7- and 14-days (7-days: OR=0.97, p=0.02; 14-days: OR=0.99, p=0.302). At all time points, a 1 SD increase in work environment lowered the odds of readmission more for Hispanic patients than White patients (OR=0.94, p<0.05 for 7- and 14-days; 30-days: OR=0.95, p<0.05; 90-days: OR=0.96, p<0.05). Evaluation of associations with specific work environment subscales revealed that each 1 SD increase in Nurse Participation in Hospital Affairs, Nursing Foundations for Quality of Care, and Staffing and Resource Adequacy were associated with a larger reduction in Hispanic patients’ odds of readmission. System-level investments in nursing resources may reduce Hispanic patient readmission disparities. This study’s findings may be used to inform the development of targeted interventions to prevent hospital readmissions for Hispanic patients.