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Brooks Carthon JM, Brom H, Grantham-Murrillo M, Sliwinski K, Mason A, Roeser M, Miles D, Garcia D, Bennett J, Harhay MO, Flores E, Amenyedor K, Clark R. Equity-Centered Postdischarge Support for Medicaid-Insured People: Protocol for a Type 1 Hybrid Effectiveness-Implementation Stepped Wedge Cluster Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e54211. [PMID: 38530349 PMCID: PMC11005441 DOI: 10.2196/54211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Disparities in posthospitalization outcomes for people with chronic medical conditions and insured by Medicaid are well documented, yet interventions that mitigate them are lacking. Prevailing transitional care interventions narrowly target people aged 65 years and older, with specific disease processes, or limitedly focus on individual-level behavioral change such as self-care or symptom management, thus failing to adequately provide a holistic approach to ensure an optimal posthospital care continuum. This study evaluates the implementation of THRIVE-an evidence-based, equity-focused clinical pathway that supports Medicaid-insured individuals with multiple chronic conditions transitioning from hospital to home by focusing on the social determinants of health and systemic and structural barriers in health care delivery. THRIVE services include coordinating care, standardizing interdisciplinary communication, and addressing unmet clinical and social needs following hospital discharge. OBJECTIVE The study's objectives are to (1) examine referral patterns, 30-day readmission, and emergency department use for participants who receive THRIVE support services compared to those receiving usual care and (2) evaluate the implementation of the THRIVE clinical pathway, including fidelity, feasibility, appropriateness, and acceptability. METHODS We will perform a sequential randomized rollout of THRIVE to case managers at the study hospital in 3 steps (4 in the first group, 4 in the second, and 5 in the third), and data collection will occur over 18 months. Inclusion criteria for THRIVE participation include (1) being Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) residing in Philadelphia; (3) having experienced a hospitalization at the study hospital for more than 24 hours with a planned discharge to home; (4) agreeing to home care at partner home care settings; and (5) being aged 18 years or older. Qualitative data will include interviews with clinicians involved in THRIVE, and quantitative data on health service use (ie, 30-day readmission, emergency department use, and primary and specialty care) will be derived from the electronic health record. RESULTS This project was funded in January 2023 and approved by the institutional review board on March 10, 2023. Data collection will occur from March 2023 to July 2024. Results are expected to be published in 2025. CONCLUSIONS The THRIVE clinical pathway aims to reduce disparities and improve postdischarge care transitions for Medicaid-insured patients through a system-level intervention that is acceptable for THRIVE participants, clinicians, and their teams in hospitals and home care settings. By using our equity-focused case management services and leveraging the power of the electronic medical record, THRIVE creates efficiencies by identifying high-need patients, improving communication across acute and community-based sectors, and driving evidence-based care coordination. This study will add important findings about how the infusion of equity-focused principles in the design and evaluation of evidence-based interventions contributes to both implementation and effectiveness outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54211. TRIAL REGISTRATION ClinicalTrials.gov NCT05714605; https://clinicaltrials.gov/ct2/show/NCT05714605.
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Affiliation(s)
| | - Heather Brom
- University of Pennsylvania, Philadelphia, PA, United States
| | | | | | - Aleigha Mason
- University of Pennsylvania, Philadelphia, PA, United States
| | - Mindi Roeser
- Pennsylvania Hospital, Philadelphia, PA, United States
| | - Donna Miles
- Pennsylvania Hospital, Philadelphia, PA, United States
| | - Dianne Garcia
- University of Pennsylvania, Philadelphia, PA, United States
| | - Jovan Bennett
- Penn Center for Community Health Workers, Philadelphia, PA, United States
| | | | - Emilia Flores
- University of Pennsylvania Health System, Philadelphia, PA, United States
| | | | - Rebecca Clark
- Pennsylvania Hospital, Philadelphia, PA, United States
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Pogue CA, Schlak AE, McHugh MD. Effect of Discharge Readiness on 30-Day Readmissions Among Older Adults Living With Multiple Chronic Conditions. Med Care 2024; 62:205-212. [PMID: 38241081 PMCID: PMC10922299 DOI: 10.1097/mlr.0000000000001976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Despite decreases in readmissions among Medicare beneficiaries after the implementation of the Hospital Readmissions Reduction Program, older adults living with multiple chronic conditions (MCCs) continue to experience higher readmission rates. Few strategies leverage nursing to identify patients at risk for readmission. OBJECTIVES Examine the effect of nurse assessments of discharge readiness on 30-day readmissions. RESEARCH DESIGN Cross-sectional study linking 3 secondary data sources (ie, nurse survey, hospital survey, and Medicare claims data) representing 424 hospitals. SUBJECTS A total of 188,806 Medicare surgical patients with MCCs. MEASURES Discharge readiness was derived from the 2016 RN4CAST-US survey. Medicare claims data was used to determine the MCC count. The outcome was 30-day readmissions across the MCC count. RESULTS The average discharge readiness score was 0.45 (range=0-0.86) indicating that, in the average hospital, <50% of nurses were confident their patient or caregiver could manage their care after discharge. Nearly 8% of patients were readmitted within 30 days of discharge; the highest rates of readmissions were among individuals with ≥5 MCCs (4293, 13.50%). For each 10% increase in the proportion of nurses in a hospital who were confident in their patients' discharge readiness, the odds of 30-day readmission decreased by 2% (95% CI: 0.96-1.00; P =0.028) for patients with 2-4 MCCs and 3% (95% CI: 0.94-0.99; P =0.015) for patients with ≥5 MCCs, relative to patients with 0-1 MCCs. CONCLUSIONS Nurse assessments of discharge readiness may be a useful signal for hospitals to reduce readmissions and examine factors interfering with discharge processes.
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Affiliation(s)
- Colleen A Pogue
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
| | | | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
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Wood EB, Brown A, Douglas CS, Lawrence J, Wotherspoon Z, Gollenberg A. Engaging Emergency Nurses in Strategies to Address the Social Determinants of Health. J Emerg Nurs 2024; 50:145-152. [PMID: 37552150 DOI: 10.1016/j.jen.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION For patients with social needs, emergency departments can be an essential bridge between the health care system and the community. Emergency nurses' knowledge of and engagement in this work need to be examined to ensure that efforts for social determinants of health screening and the resulting community connections are effective. However, there is limited research in this area of nursing practice. The purpose of this study is to describe emergency nurses' knowledge about social needs in their community, assess their knowledge of existing community resources, and examine their perceived confidence to respond to the social needs of their patients. METHODS A cross-sectional survey was conducted with 243 nurses employed in a large regional health care system. Data were collected using an adapted 81-item social determinants of health survey instrument to measure knowledge of social determinants of health, confidence, and frequency of discussing social determinants of health with emergency department patients and awareness of social resources available in the community. Survey participants were asked about barriers to incorporating social determinants of health into their emergency department workflow and to provide general demographic information. Descriptive statistics were used to analyze study results. RESULTS Most of the 243 emergency nurse participants believed that addressing social determinants of health was important and that emergency nurses should be involved in issues around social determinants of health. However, most nurses reported limited knowledge about social determinants of health and had very limited knowledge about the resources available in their community to help patients with needs related to food, housing, medical care, and transportation. Nurses reported that although they know that their patients are unlikely to ask for help with social needs during an emergency department visit, they are still unlikely to ask their patients about social needs owing to low confidence about having social needs conversations, limited time, and competing care priorities. Participants advocated for greater case manager presence. Feeling connected to the community was significantly correlated to increased knowledge, confidence, and likelihood to ask about social needs (P < .05). DISCUSSION The emergency department is a logical place for screening for social determinants of health and connecting patients with social needs to community resources. Emergency nurses included in this study acknowledged that they want to address the social needs of their patients but reported that they lack knowledge about both social determinants of health and more importantly about the resources available to help patients with social needs. In general, they did not feel confident discussing social determinants of health with their patients in the emergency department and are unlikely to ask about social needs. Barriers to screening include time, competing care priorities, and lack of knowledge and support needed from case managers. Findings from this study have implications for supporting emergency nurses employed in institutions that seek to address social influences of health for the patients in their communities.
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Brooks Carthon M, Muir J, Iroegbu C, Langston C, Amenyedor K, Nikpour J, Lasater KB, McHugh M, Kutney-Lee A. COVID-19 Mortality Disparities Among Socially Vulnerable Medicare Beneficiaries Associated With the Quality of Nurse Work Environments in U.S. Hospitals. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241284959. [PMID: 39323090 DOI: 10.1177/00469580241284959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
COVID-19 mortality disparities for socially vulnerable patients, including individuals facing higher levels of poverty, housing insecurity, and limited transportation, have been linked to the quality of hospitals where they received care. Few studies have examined the specific aspects of hospitals, such as nursing care quality, that may underlie disparate outcomes. Recent studies suggest that nursing resources in the pre-pandemic period were associated with mortality during the COVID-19 public health emergency. In this study, we examined the association between social vulnerability, the nurse work environment, and inpatient mortality among Medicare beneficiaries hospitalized with COVID-19. A cross-sectional analysis was conducted of linked survey data collected from nurses working in New York and Illinois, Medicare claims, American Hospital Association Annual Survey data, and the Social Vulnerability Index (SVI). Higher mortality rates were observed among patients in the highest quartile of social vulnerability compared to the lowest (6870 [25.8%] vs 5019 [19.1%]; P < .001). Using multivariable regression modeling, a statistically significant interaction was found between the highest SVI quartile and the nurse work environment (OR, 0.86; 95% CI, 0.76-0.98; P < .05), implying that the effect of a higher quality nurse work environment on mortality was decidedly greater for patients in the highest quartile (odds ratio = 0.86 × 0.94 = 0.80) compared to patients in the lowest quartile (OR, 0.94). Post-hoc analyses demonstrated that hundreds of COVID-19 related deaths among the most socially vulnerable patients may have been avoided if all hospitals had a high-quality nurse work environment. Strengthening the quality of nurse work environments may help to reduce health disparities and should be considered in public health emergency planning, specifically in hospitals serving socially vulnerable communities.
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Affiliation(s)
| | - Jane Muir
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Christin Iroegbu
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Kelvin Amenyedor
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Karen B Lasater
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Matthew McHugh
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ann Kutney-Lee
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
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Mizumoto J, Son D, Izumiya M, Horita S, Eto M. The impact of patients' social backgrounds assessment on nursing care: Qualitative research. J Gen Fam Med 2023; 24:332-342. [PMID: 38025935 PMCID: PMC10646291 DOI: 10.1002/jgf2.650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/10/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Although nurses are expected to address the social determinants of health (SDH) in clinical settings, the perspectives of front-line nurses on the integration of SDH into their clinical practice remain unclear. Understanding the dynamism of this integration and its outcomes can yield crucial insights into effective nursing care. This study aims to elucidate the integration and adoption of tool-based SDH assessment nursing programs and their impacts on daily nursing care. Methods We conducted qualitative research at a small community-based hospital in Japan, where a tool-based program characterized by social background interviews and documentation was implemented. Nurses at the hospital were recruited via purposive and snowball sampling. After hypothesis generation, semi-constructed in-depth online interviews were conducted. Each interview lasted between 30 and 50 min. The data were analyzed via thematic analysis using the framework approach. Results A total of 16 nurses participated. Participants' incorporation of the novel SDH assessment program was bolstered by prior learning and their recognition of its practical value. Institutional support and collaborative teamwork further facilitated the adoption of this innovation. Enhanced knowledge about the social contexts of their patients contributed to increased respect, empathy, and self-affirmation among participants, consequently enhancing the quality of nursing care. Conclusion Through team-based learning, reflection, and support, nurses can integrate a tool-based SDH assessment program into their daily nursing practice. This program has the potential to empower nurses to deliver more holistic care and redefine their professional identity. Further research is warranted to assess patient-reported outcomes.
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Affiliation(s)
- Junki Mizumoto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Daisuke Son
- Department of Community‐based Family Medicine, School of MedicineTottori University Faculty of MedicineYonagoJapan
| | - Masashi Izumiya
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Shoko Horita
- Center for Medical Education, School of MedicineTeikyo UniversityTokyoJapan
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of MedicineThe University of TokyoTokyoJapan
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Watts T, Green JE. Collaborating With Community Partners to Address Population Health in an Online Advanced Nursing Practice Course. Nurse Educ 2023; 48:310-315. [PMID: 37011640 DOI: 10.1097/nne.0000000000001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Engaging in effective community partnerships is a core competency for advanced nursing practice. PURPOSE To describe a semester-long population health project that involved collaboration with a community partner in an online and asynchronous advanced nursing practice course and to evaluate students' perceptions of their community partner collaboration. METHODS At the beginning of the course, students selected health topics and community partners. Perceptions of the collaboration were evaluated in a survey. Data were analyzed using descriptive statistics and content analysis. RESULTS Approximately 59% of the students found the community partnership was very valuable. Barriers for working with community partners included reluctancy, feeling like a burden, and challenges with scheduling. Facilitators for working with community partners included receiving support on the project, gaining new perspectives, and the collaborative relationship. CONCLUSIONS Community partnership assignments on population health projects can support students in obtaining skills on effective community partnerships while they are in their education programs.
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Affiliation(s)
- Theresa Watts
- Assistant Professor, Orvis School of Nursing (Dr Watts) and PhD candidate, Political Science Department (Ms Green), University of Nevada-Reno
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Wu N, Li M. A CiteSpace-Based Analysis of the Development Trends Affecting Clinical Research Nurses in China: A Systematic Review. J Multidiscip Healthc 2022; 15:2363-2374. [PMID: 36277119 PMCID: PMC9586125 DOI: 10.2147/jmdh.s363741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/23/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To examine the developmental characteristics and trends affecting clinical research nurses (CRNs) in China and provide a reference for the training and employment of nursing talents in this specialty. METHODS Literature pertaining to CRNs published from the year in which the database was constructed to 2020 was searched. The databases used were the China National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature and Weipu, while CiteSpace software was used to conduct a bibliometric analysis of literature quantity, annual distribution, literature journals and regional distribution, literature authors, subject funding status and literature type and keywords. The characteristics and trends affecting CRNs in China were then evaluated using a descriptive analysis. RESULTS A total of 3735 pieces of literature were retrieved, and after deduplication and screening, 199 pieces of literature were retained for this study. Overall, the number of publications increased year-on-year. Of these publications, 17 papers (8.5% of the retained papers) were published in the Chinese Journal of Modern Nursing and 9138 papers (69.3%) were published in the top 10 regions according to the location of the first author (of these, 31 [15.6%] were published in Beijing and 42 [21.1%] were funded by scientific research funds). The research fell mainly in the experience summary category, with 107 articles (53.8%) taking this approach. The top five research hotspots were clinical research, good clinical practice (GCP), research nurses, management and clinical trials. The practice and exploration of CRNs were regionalised, accounting for varying degrees of development. CRNs were found to be at the forefront of developments in oncology specialties. CONCLUSION In China, CRNs are currently in a period of rapid development. Research into CRNs mainly involves single-centre studies and lacks financial support. In the future, it will be necessary to increase capital investment, strengthen cross-regional cooperation between authors and institutions to narrow the regional development gap, and promote strict and standardised CRN training models and qualification certification to improve the quality of clinical research nursing.
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Affiliation(s)
- Ning Wu
- Department of Nursing, Shanxi Provincial People’s Hospital, Taiyuan, 030012, People’s Republic of China
| | - Mingzi Li
- Peking University, School of Nursing, Beijing, 100191, People’s Republic of China,Correspondence: Mingzi Li, Peking University, School of Nursing, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, People’s Republic of China, Tel +86 010-82805230, Email
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Brooks Carthon JM, Brom H, French R, Daus M, Grantham-Murillo M, Bennett J, Ryskina K, Ponietowicz E, Cacchione P. Transitional care innovation for Medicaid-insured individuals: early findings. BMJ Open Qual 2022; 11:bmjoq-2021-001798. [PMID: 35981741 PMCID: PMC9345087 DOI: 10.1136/bmjoq-2021-001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022] Open
Abstract
BackgroundChronically ill adults insured by Medicaid experience health inequities following hospitalisation.Local problemPostacute outcomes, including rates of 30-day readmissions and postacute emergency department (ED), were higher among Medicaid-insured individuals compared with commercially insured individuals and social needs were inconsistently addressed.MethodsAn interdisciplinary team introduced a clinical pathway called ‘THRIVE’ to provide postacute wrap-around services for individuals insured by Medicaid.InterventionEnrolment into the THRIVE clinical pathway occurred during hospitalisation and multidisciplinary services were deployed into homes within 48 hours of discharge to address clinical and social needs.ResultsCompared with those not enrolled in THRIVE (n=437), individuals who participated in the THRIVE clinical pathway (n=42) experienced fewer readmissions (14.3% vs 28.4%) and ED visits (14.3% vs 28.8 %).ConclusionTHRIVE is a promising clinical pathway that increases access to ambulatory care after discharge and may reduce readmissions and ED visits.
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Affiliation(s)
| | - Heather Brom
- College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Rachel French
- National Clinician Scholars Program Center for Mental Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marguerite Daus
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), VA Eastern Colorado Health Care System, Denver, Colorado, USA
| | | | - Jovan Bennett
- Penn Center for Community Health Workers, Philadelphia, Pennsylvania, USA
| | - Kira Ryskina
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Pamela Cacchione
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Brom H, Anusiewicz CV, Udoeyo I, Chittams J, Brooks Carthon JM. Access to post-acute care services reduces emergency department utilisation among individuals insured by Medicaid: An observational study. J Clin Nurs 2022; 31:726-732. [PMID: 34240494 PMCID: PMC8741822 DOI: 10.1111/jocn.15932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES We examined whether access to post-acute care services differed between individuals insured by Medicaid and commercial insurers and whether those differences explained emergency department utilisation 30 days post-hospitalisation. BACKGROUND Timely follow-up to community-based providers is a strategy to improve post-hospitalisation outcomes. However, little is known regarding the influence of post-acute care services on the likelihood of emergency department use post-hospitalisation for individuals insured by Medicaid. DESIGN We conducted a retrospective observational study of electronic health record data from an academic medical centre in a large northeastern urban setting. The STROBE checklist was used in reporting this observational study. METHODS Our analysis included adults insured by Medicaid or commercial insurers who were discharged from medical services between 1 August-31 October 2017 (n = 785). Logistic regression models were used to examine the effects of post-acute care services (primary care, home health, specialty care) on the odds of an emergency department visit. RESULTS Post-hospitalisation, 12% (n = 59) of individuals insured by Medicaid experienced an emergency department visit compared to 4.2% (n = 13) of individuals commercially insured. Having Medicaid insurance was associated with higher odds of emergency department visits post-hospitalisation (OR = 3.24). Having a home care visit or specialty care visit within 30 days post-discharge were significant predictors of lower odds of emergency department visits. Specific to specialty care visits, Medicaid was no longer a significant predictor of emergency department visits with specialty care being more influential (OR = 0.01). CONCLUSIONS Improving connections to appropriate post-acute care services, specifically specialty care, may improve outcomes among individuals insured by Medicaid. RELEVANCE TO CLINICAL PRACTICE Hospital-based nurses, including those in direct care, case management and discharge planning, play an important role in facilitating referrals and scheduling appointments prior to discharge. Individuals insured by Medicaid may require additional support in accessing these services and nurses are well-positioned to facilitate care continuity.
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Affiliation(s)
- Heather Brom
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Colleen V. Anusiewicz
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Danville, PA, USA
| | | | - Jesse Chittams
- BECCA Lab, University of Pennsylvania, Philadelphia, PA, USA
| | - J. Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Danville, PA, USA
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Abstract
BACKGROUND Racial minorities are disproportionately affected by stroke, with Black patients experiencing worse poststroke outcomes than White patients. A modifiable aspect of acute stroke care delivery not yet examined is whether disparities in stroke outcomes are related to hospital nurse staffing levels. OBJECTIVES The aim of this study was to determine whether 7- and 30-day readmission disparities between Black and White patients were associated with nurse staffing levels. METHODS We conducted a secondary analysis of 542 hospitals in four states. Risk-adjusted, logistic regression models were used to determine the association of nurse staffing with 7- and 30-day all-cause readmissions for Black and White ischemic stroke patients. RESULTS Our sample included 98,150 ischemic stroke patients (87% White, 13% Black). Thirty-day readmission rates were 10.4% (12.7% for Black patients, 10.0% for White patients). In models accounting for hospital and patient characteristics, the odds of 30-day readmissions were higher for Black than White patients. A significant interaction was found between race and nurse staffing, with Black patients experiencing higher odds of 30- and 7-day readmissions for each additional patient cared for by a nurse. In the best-staffed hospitals (less than three patients per nurse), Black and White stroke patients' disparities were no longer significant. DISCUSSION Disparities in readmissions between Black and White stroke patients may be linked to the level of nurse staffing in the hospitals where they receive care. Tailoring nurse staffing levels to meet the needs of Black ischemic stroke patients represents a promising intervention to address systemic inequities linked to readmission disparities among minority stroke patients.
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Brom H, Brooks Carthon JM, Sloane D, McHugh M, Aiken L. Better nurse work environments associated with fewer readmissions and shorter length of stay among adults with ischemic stroke: A cross-sectional analysis of United States hospitals. Res Nurs Health 2021; 44:525-533. [PMID: 33650707 DOI: 10.1002/nur.22121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/15/2021] [Accepted: 02/13/2021] [Indexed: 02/04/2023]
Abstract
Stroke is among the most common reasons for disability and death. Avoiding readmissions and long lengths of stay among ischemic stroke patients has benefits for patients and health care systems alike. Although reduced readmission rates among a variety of medical patients have been associated with better nurse work environments, it is unknown how the work environment might influence readmissions and length of stay for ischemic stroke patients. Using linked data sources, we conducted a cross-sectional analysis of 543 hospitals to evaluate the association between the nurse work environment and readmissions and length of stay for 175,467 hospitalized adult ischemic stroke patients. We utilized logistic regression models for readmission to estimate odds ratios (OR) and zero-truncated negative binomial models for length of stay to estimate the incident-rate ratio (IRR). Final models accounted for hospital and patient characteristics. Seven and 30-day readmission rates were 3.9% and 10.1% respectively and the average length of stay was 4.9 days. In hospitals with better nurse work environments ischemic stroke patients experienced lower odds of 7- and 30-day readmission (7-day OR, 0.96; 95% confidence interval [CI]: 0.93-0.99 and 30-day OR, 0.97; 95% CI: 0.94-0.99) and lower length of stay (IRR, 0.97; 95% CI: 0.95-0.99). The work environment is a modifiable feature of hospitals that should be considered when providing comprehensive stroke care and improving post-stroke outcomes.
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Affiliation(s)
- Heather Brom
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - J Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas Sloane
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathew McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Phillips J, Richard A, Mayer KM, Shilkaitis M, Fogg LF, Vondracek H. Integrating the Social Determinants of Health into Nursing Practice: Nurses' Perspectives. J Nurs Scholarsh 2020; 52:497-505. [DOI: 10.1111/jnu.12584] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Janice Phillips
- Gamma Phi Director of Nursing Research and Health Equity Rush University Medical Center, and Associate Professor Rush University College of Nursing Chicago IL USA
| | - Angelique Richard
- Gamma Phi, Chief Nursing Executive and Rush System Acting Senior Vice President Hospital Operations, and Rush University Medical Center Vice President, and Clinical Nursing & Chief Nursing Officer Rush University Medical Center, and Associate Dean for Practice Rush UniversityCollege of Nursing Chicago IL USA
| | - Karen M. Mayer
- Gamma Phi, Vice President Patient Care Services Rush Oak Park Hospital, Oak Park, IL, and Assistant Professor Rush University College of Nursing Chicago IL USA
| | - Mary Shilkaitis
- Senior Vice President Chief Operations Officer Rush Copley Medical Center Aurora IL USA
| | - Louis F. Fogg
- Associate Professor Rush University College of Nursing Chicago IL USA
| | - Hugh Vondracek
- Data Analyst Rush University College of Nursing Chicago IL USA
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French R, McHugh MD, Lake E, Brooks Carthon JM. A Systematic Review of Care Needs for Surgical Patients with Chronic Opioid Use. MEDSURG NURSING : OFFICIAL JOURNAL OF THE ACADEMY OF MEDICAL-SURGICAL NURSES 2020; 29:245-254. [PMID: 34079200 PMCID: PMC8168975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An understudied aspect of the opioid crisis with implications for nursing is care of hospitalized surgical patients with chronic opioid use. Care needs of these patients are not well understood. This systematic review identified salient care needs and explored the role of nursing in meeting these needs.
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Affiliation(s)
- Rachel French
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Matthew D McHugh
- Center for Health Outcomes & Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Eileen Lake
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
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Herrera CN, Brochier A, Pellicer M, Garg A, Drainoni ML. Implementing Social Determinants of Health Screening at Community Health Centers: Clinician and Staff Perspectives. J Prim Care Community Health 2020; 10:2150132719887260. [PMID: 31702425 PMCID: PMC6843733 DOI: 10.1177/2150132719887260] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose: Screening for social determinants of health (SDOH) during primary care office visits is recommended by pediatric and internal medicine professional guidelines. Less is known about how SDOH screening and service referral can be successfully integrated into clinical practice. Methods: Key informant interviews with 11 community health center (CHC) clinicians and staff members (medical assistants and case managers) were analyzed to identify themes related to integrating a SDOH screening and referral process (augmented WE CARE model) into their workflow. Results: CHC clinicians and staff believed the augmented WE CARE model benefited their patients and the CHC’s mission. Most clinicians found the model was easy to implement. Some staff members had difficulty prioritizing the nonclinical intervention and were confused about their roles and the role of the patient navigator. The eligibility requirements and time needed to access local SDOH resources frustrated clinicians. Discussion: SDOH screening and referral care models can help support the mission of CHCs by identifying unmet material needs. However, CHCs have organizational and administrative challenges that successful interventions must address. CHCs need clinical champions for SDOH models because the screening and follow-up processes involve clinical staff. Additional support for SDOH models might include piloting the SDOH screening model workflow and formalizing the workflow before implementation, including the specific roles for clinicians, staff, and patient navigators.
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Dierckx de Casterlé B, Mertens E, Steenacker J, Denier Y. Nurses’ experiences of working under time pressure in care for older persons. Nurs Ethics 2020; 27:979-990. [DOI: 10.1177/0969733019895797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The international health workforce crisis had led to an increasing shortage of nurses, which has substantial implications for the quality of patient care. This shortage potentially results in nurse-perceived time pressure, which can be particularly challenging for nurses who provide care for older persons. Objective This study aimed to show how geriatric nurses experience working under time pressure, perceive its impact on care and deal with time pressure in daily care. Research design A qualitative descriptive interview design was used. Participants and research context Purposive sampling led to the inclusion of 11 nurses from three geriatric nursing wards in two general hospitals in Flanders (Belgium). Data were collected using semi-structured in-depth interviews and analysed using the QUAGOL (Qualitative Analysis Guide of Leuven). Ethical considerations The study protocol was approved by the Ethics Committee of the University Hospitals Leuven (Ethics committee of the University Hospitals Leuven). Findings In all interviews, time pressure was described as ubiquitous in the daily care of older persons. A sense of failure in providing care was the common thread in many interviews. Nurses felt compelled to ‘reduce’ good-quality care to basic care by focusing on the physical and visible aspects of care. Nevertheless, personal experiences with time pressure and strategies to cope with it differed among the interviewees. These variations were related to the working environment and the nurses themselves. They underscored the importance of nurses’ perspectives for a good understanding of the phenomenon of time pressure. Discussion and conclusion Working under time pressure in the care of older persons leads to various important challenges for nursing ethics. The findings show that providing care that promotes the human dignity of older persons in busy working environments in which care is rationed is an important ethical challenge. As such, our study offers a baseline for further research and discussion on how to support nurses working under time pressure.
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Irani E, Hirschman KB, Cacchione PZ, Bowles KH. The Role of Social, Economic, and Physical Environmental Factors in Care Planning for Home Health Care Recipients. Res Gerontol Nurs 2019; 13:130-137. [PMID: 31834411 DOI: 10.3928/19404921-20191210-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/15/2019] [Indexed: 11/20/2022]
Abstract
Social, economic, and environmental factors contribute to patients' recovery following hospitalization. However, little is known about how home health nurses make decisions based on their assessment of these factors. The purpose of the current study was to explore the nonclinical factors that home health nurses evaluate and describe how these factors influence care planning decisions. Semi-structured interviews conducted with 20 visiting nurses from three home health agencies were analyzed using conventional content analysis. Three nonclinical factor themes emerged: Social Support, Home Environment and Neighborhood, and Finances and Insurance Barriers. Nurses' assessments guided them to include family caregivers in the plan of care, evaluate their own safety to complete home visits, and refer patients to useful resources. Findings highlight the role of home health nurses in supporting older adults with limited resources and the need to address the social determinants of health across the care continuum. [Research in Gerontological Nursing, 13(3), 130-137.].
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