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Individual Nurse Productivity in Preparing Patients for Discharge Is Associated With Patient Likelihood of 30-Day Return to Hospital

  • Yakusheva, Olga1
  • Weiss, Marianne E.2
  • Bobay, Kathleen L.3
  • Costa, Linda4
  • Hughes, Ronda G.5
  • Hamilton, Morris6
  • Bang, James7
  • Buerhaus, Peter I.8
  • 1 & Department of Health Management and Policy, School of Public Health, Ann Arbor, MI
  • 2 Marquette University College of Nursing, Milwaukee, WI
  • 3 Loyola University Chicago, Chicago, IL
  • 4 University of Maryland, College Park, MD
  • 5 University of South Carolina, Columbia, SC
  • 6 Abt Associates, Durham, NC
  • 7 Department of Finance, Economics, and Decision Science, St Ambrose University, Davenport, IA
  • 8 College of Nursing, Montana State University, Bozeman, MT
Published Article
Medical Care
Lippincott Williams & Wilkins
Publication Date
Jul 18, 2019
DOI: 10.1097/MLR.0000000000001170
PMID: 31335757
PMCID: PMC6693983
PubMed Central


Objective: Applied to value-based health care, the economic term “individual productivity” refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient’s likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits]. Research Design: Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics. Subjects: A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016. Measures: Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return. Results: Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (−0.48 absolute percentage points, P <0.001) and an ED visit (−0.29 absolute percentage points, P =0.042). Conclusions: Variability in individual clinician productivity can have implications for acute care quality patient outcomes.

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