Reducing Hospital Readmission Disparities of Older Black and White Adults After Elective Joint Replacement: The Role of Nurse Staffing

OBJECTIVES: To examine racial differences in readmissions of older adults undergoing elective total hip and knee replacement, to determine the relationship between nurse staffing and readmission, and to study whether the relationship between staffing and readmission differs for older black and white adults. DESIGN: Cross-sectional analysis of multiple linked secondary data sources. SETTING: Nonfederal acute care hospitals in California, Florida, New Jersey, and Pennsylvania (n = 483). PARTICIPANTS: Patients aged 65 and older undergoing elective total hip or total knee replacement (N = 106,848; n = 102,762 white, n = 4,086 black). MEASUREMENTS: Unplanned readmission within 30 days of discharge. RESULTS: Older black patients were more likely to have an unplanned readmission (7.5%) than their white counterparts (5.6%). Even after adjusting for patient- and hospital-level factors, older black patients had 40% greater likelihood of readmission (odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.21-1.61). Each additional patient per nurse was associated with 8% greater odds of readmission for older white patients (OR = 1.08, 95% CI = 1.01-1.15) and 15% greater odds for older black patients (OR = 1.15, 95% CI = 1.08-1.22) after adjusting for patient- and hospital-level factors. CONCLUSION: Older minorities are more likely than their white counterparts to experience an unplanned readmission after elective orthopedic surgery. More-favorable nurse staffing was associated with lower odds of readmission of older black and white patients, but better-staffed hospitals had a greater protective effect for older black patients.