C9. Lower postsurgical readmission for individuals with opioid related disorders with better educated hospital nurse workforce

C9. Lower postsurgical readmission for individuals with opioid related disorders with better educated hospital nurse workforce

C9. Lower Postsurgical Readmission for Individuals with Opioid Related Disorders with Better‐Educated Hospital Nurse Workforce

Learner category:

• Novice Level
• Intermediate Level

Learning objectives:

•  Participants will be able to understand that surgical patients with opioid related disorders (ORD) have higher odds of 30-day readmission than those
  without ORD
• Participants will explore and identify a strategy to improve the odds of good outcomes for surgical patients with ORD

Abstract:

Surgical patients with opioid related disorders (ORD) require specialized care when hospitalized. Evidence suggests that outcomes of complex patients are better when patients are cared for in hospitals with more baccalaureate nurses (BSNs). The purpose of this study was to determine if surgical patients with ORD had lower odds of 30-day readmissions when cared for in hospitals with higher proportions of BSNs. A crosssectional analysis of three linked data sources from 2016 was utilized: 1) RN4CAST-US Nurse Survey, 2) American Hospital Association Annual Survey and 3) patient discharge data. Riskadjusted logistic regression models were used to estimate the association between 30-day readmissions, having an ORD, and hospital percentage of BSNs in the hospital. Fully adjusted multiple logistic regression models controlled for patient and hospital characteristics. The sample included 914,254 surgical patients in 453 hospitals in four states (California, Florida, New Jersey, Pennsylvania). Surgical patients with ORD accounted for 1.45% of surgical patients. In fully adjusted models, surgical patients with ORD had 29% higher odds of 30-day readmission (OR 1.29; 95% CI 1.21-1.38) compared to surgical patients without ORD. Each 10% increase in the proportion of nurses with a BSN was associated with 4% lower odds of 30-day readmission for surgical patients with ORD (OR 0.96; 95% CI 0.93-1.00). Surgical patients with ORD have higher odds of 30-day readmission than those without ORD. Having more BSN nurses in hospitals improves the odds of good outcomes for surgical patients with ORD. Patients with ORD will continue to undergo surgery.

Author(s):

Rachel French, BSN, RN
University of Pennsylvania, United States

Rachel French is a second-year predoctoral fellow at CHOPR. She holds a BSN from Boston College. Rachel worked as an RN in Boise, ID at a Federally Qualified Health Center that provided primary care and medication assisted treatment to a largely underserved population. Her research interests include leveraging nursing resources to improve patient outcomes and reduce health disparities for hospitalized patients with comorbid opioid use disorder. She is passionate about her work with opioid addiction and is interested in evaluating the role of nurses in addressing the opioid crisis.

Matthew McHugh, PhD, JD, MPH, University of Pennsylvania

Matthew D. McHugh, PhD, JD, MPH, CRNP, RN, FAAN is a nursing outcomes and policy researcher. He is a 2011 Robert Wood Johnson Foundation Nurse Faculty Scholar and Associate Director of Penn’s Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. He is also a Fellow in interdisciplinary collaborative research centers at Penn including the Leonard Davis Institute of Health Economics, the Center for Public Health Initiatives, the Institute on Aging, the Institute on Urban Research, and the Population Studies Center. Dr. McHugh is a family nurse practitioner and psychiatric–mental health clinical nurse specialist. He received his his ASN and BSN in nursing from Gwynedd-Mercy College, his MSN and PhD in nursing from the University of Pennsylvania, a master of public health degree from the Harvard School of Public Health, and a juris doctor degree from the Northeastern University School of Law. Dr. McHugh was a Fulbright Scholar with the World Health Organization (WHO) Regional Office for Europe in Denmark. He completed a 2-year post-doctoral fellowship in nursing outcomes research at the University of Pennsylvania.

Linda Aiken, PhD, RN, University of Pennsylvania

Dr. Aiken is the Director of the Center for Health Outcomes and Policy Research, and The Claire M. Fagin Leadership Professor of Nursing and Professor of Sociology at the University of Pennsylvania, Philadelphia. Dr. Aiken conducts research on the health care workforce and quality of health care in the U.S. and globally. She co-directs RN4CAST, a European Union funded study of nurse workforce and quality of care in 12 European countries, China, and South Africa and directs RN4Cast-United States, a NINR-funded study of the outcomes of nursing care in hospitals, nursing homes, home care, and office-based practices. Her funded NIH research has received numerous awards including the Individual Codman Award from the Joint Commission on Accreditation of Healthcare Organizations for leadership utilizing performance measures to demonstrate relationships between nursing care and patient outcomes.

J. Margo Brooks Carthon, PhD, RN, FAAN, University of Pennsylvania

Dr. Brooks Carthon’s work focuses on nursing outcomes research and the relationship between the organization of nursing services and health disparities among vulnerable patient populations. She is among the first to provide evidence that racial disparities in hospital-based outcomes are associated with poor nursing quality. This path breaking work shows that targeted investments in nursing in minority-serving hospitals have the potential to reduce what have been intractable health disparities in the areas of hospital readmissions, patient satisfaction and post-surgical mortality. Dr. Brooks Carthon is equally regarded as a thought leader in the area of nursing workforce diversity. Leveraging years of work locally and nationally in the areas of recruitment and retention of underrepresented minorities, Dr. Brooks Carthon has been instrumental in the creation of national policies to address diversity and inclusion in nursing education. She is an alumna of the Robert Wood Johnson Nurse Faculty Scholars Program, and a Fellow of the American Academy of Nursing. Her study findings may be found in interdisciplinary journals including JAMA, BMJ Quality & Safety, the Journal of the American Geriatrics Society and Medical Care.