title: Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA. mchughm@nursing.upenn.edu
authors.forename: Matthew D
authors.initials: MD
authors.lastname: McHugh
authors.forename: Chenjuan
authors.initials: C
authors.lastname: Ma
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015400:Clinical Nursing Research; D004506:Education, Nursing / Q000706:statistics & numerical data; D004777:Environment; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000451:nursing*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000453:epidemiology / Q000451:nursing*; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration / Q000706:statistics & numerical data; D011014:Pneumonia / Q000453:epidemiology / Q000451:nursing*; D011787:Quality of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D012737:Sex Factors; D014481:United States; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data