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Unmet nursing care may lead to rehospitalizations for black patients with acute MI
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Black patients with acute MI who do not receive all necessary nursing care are more likely than their white counterparts to be readmitted to the hospital within the first 30 days after discharge, researchers reported in Medical Care.
“Our findings suggest that unmet nursing care varies widely across U.S. hospitals and that older blacks disproportionately receive care in settings where care is missed more often,” J. Margo Brooks-Carthon, PhD, RN, from the University of Pennsylvania School of Nursing’s Center for Health Outcomes and Policy Research, said in a press release.
J. Margo Brooks-Carthon
Brooks-Carthon and colleagues conducted a cross-sectional analysis of 2006 and 2007 data from administrative discharge records, the Multi-State Nursing Care and Patient Safety Study of Registered Nurses and the American Hospital Association Annual Survey. The final sample included 69,065 patients (aged 65 to 90 years) with acute MI, 14,879 nurses and 253 hospitals in California, New Jersey and Pennsylvania. The primary endpoint was all-cause readmission within 30 days of discharge.
Ninety-four percent of the patients were white and 6% were black. The black patients were more often younger, came from a lower socioeconomic status and had more comorbidities. Compared with older white patients, older black patients were also more often admitted to hospitals with poor nurse work environment (51.4% vs. 44.4%), although these hospitals tended to be better staffed (19.7% vs. 16.9%).
Although reasons for re-admittance were similar across race (HF, acute MI, coronary atherosclerosis), more black patients returned to the hospital in the first 30 days than white patients (23.5% vs. 18.8%), for a 16% greater likelihood of readmission compared with white patients (OR = 1.16; 95% CI, 1.06-1.27). The odds of readmission for black patients increased when the following nursing care needs were not met: comforting and talking with patients (OR = 1.09; 95% CI, 1-1.19), documenting care (OR = 1.16; 95% CI, 1.01-1.32) and administering medications in a timely manner (OR = 1.26; 95% CI, 1.09-1.46).
Unmet nursing care, however, did not seem to affect readmission rates for white patients. – by Tracey Romero
D isclosure: The researchers report no relevant financial disclosures.
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