Health Affairs: High nurse staffing linked to lower readmission penalties

Hospitals with higher nurse staffing had 25 percent lower odds of being penalized for hospital readmissions within 30 days compared to otherwise similar hospitals with lower staffing, according to a study published in Health Affairs.

Inadequate nursing hinders efforts to carry out evidence-based interventions, such as discharge preparation, care coordination and patient education, which “are grounded in the fundamentals of basic nursing care,” wrote lead author Matthew D. McHugh, associate professor of nursing at the Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, and a senior fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania, in Philadelphia, et al.

McHugh and his team analyzed data from the Center for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program (HRRP) for fiscal year 2013 to identify HRRP penalties at 2,976 adult, non-federal and acute care hospitals (Maryland is excluded). The study sample was limited to hospitals with at least 25 cases of heart failure, acute myocardial infarction or pneumonia between July 1, 2008, and June 31, 2011.

Researchers used a matching approach to carry out an “apples to apples” comparison of HRRP penalties between well-staffed hospitals and otherwise similar hospitals with lower staffing levels, according to the paper.

“Among a national sample of hospitals, we found that even after closely matching on hospital and patient population characteristics, hospitals with better registered nurse staffing levels were significantly less likely to be penalized under the CMS HRRP than otherwise similar hospitals that were less well staffed,” McHugh et al wrote. Concurrently, the researchers found that a greater proportion of patients in better-staffed hospitals rated their hospital highly and would recommend it to friends and family.

Additionally, a small but significantly greater proportion of patients in well-staffed hospitals reported that they were given information that would help them recover at home, compared to patients discharged from the comparison hospitals, according to the report.

Investment in nursing to reduce readmissions should be considered by policy makers and hospital administrators to improve the quality of care delivered to U.S. hospital patients, the report concluded.

More information on the report is here.