Marianne E. Weiss

Psychometric Properties of the Readiness for Hospital Discharge Scale

The purpose of the study was to assess the psychometrics properties of the Readiness for Hospital Discharge Scale (RHDS), a 23-item instrument that measures patients’ perception of readiness for discharge. Data were obtained from 356 respondents from two urban tertiary medical centers (adult and children’s) in the midwestern United States who were participants in a larger study of predictors and outcomes of readiness for hospital discharge. Confirmatory factor analysis, contrasted group comparisons, and predictive validity testing supported the 4-factor structure and construct validity of the instrument. Following deletion of two poorly performing items, Cronbach’s alpha for the revised 21item scale was 0.90. The RHDS can be a useful tool for measurement of readiness for discharge for clinical and research purposes.

Environment and obesity in the National Children's Study.

Objective In this review we describe the approach taken by the National Children’s Study (NCS), a 21-year prospective study of 100,000 American children, to understanding the role of environmental factors in the development of obesity. Data sources and extraction We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis. Data synthesis Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of factors in the modern built environment and chemical exposures that may have the capacity to disrupt the link between energy intake and expenditure. The NCS is the largest prospective birth cohort study ever undertaken in the United States that is explicitly designed to seek information on the environmental causes of pediatric disease. Conclusions Through its embrace of the life-course approach to epidemiology, the NCS will be able to study the origins of obesity from preconception through late adolescence, including factors ranging from genetic inheritance to individual behaviors to the social, built, and natural environment and chemical exposures. It will have sufficient statistical power to examine interactions among these multiple influences, including gene–environment and gene–obesity interactions. A major secondary benefit will derive from the banking of specimens for future analysis.

Quality and Cost Analysis of Nurse Staffing, Discharge Preparation, and Postdischarge Utilization

OBJECTIVES To determine the impact of unit-level nurse staffing on quality of discharge teaching, patient perception of discharge readiness, and postdischarge readmission and emergency department (ED) visits, and cost-benefit of adjustments to unit nurse staffing. DATA SOURCES Patient questionnaires, electronic medical records, and administrative data for 1,892 medical-surgical patients from 16 nursing units within four acute care hospitals between January and July 2008. DESIGN Nested panel data with hospital and unit-level fixed effects and patient and unit-level control variables. DATA COLLECTION/EXTRACTION Registered nurse (RN) staffing was recorded monthly in hours-per-patient-day. Patient questionnaires were completed before discharge. Thirty-day readmission and ED use with reimbursement data were obtained by cross-hospital electronic searches. PRINCIPAL FINDINGS Higher RN nonovertime staffing decreased odds of readmission (OR=0.56); higher RN overtime staffing increased odds of ED visit (OR=1.70). RN nonovertime staffing reduced ED visits indirectly, via a sequential path through discharge teaching quality and discharge readiness. Cost analysis projected total savings from 1 SD increase in RN nonovertime staffing and decrease in RN overtime of U.S.

Nurse and patient perceptions of discharge readiness in relation to postdischarge utilization.

11.64 million and U.S.

Economic evaluation of the 80% baccalaureate nurse workforce recommendation: A patient-level analysis

544,000 annually for the 16 study units. CONCLUSIONS Postdischarge utilization costs could potentially be reduced by investment in nursing care hours to better prepare patients before hospital discharge.

Age-Related Differences in Perception of Quality of Discharge Teaching and Readiness for Hospital Discharge

Background:Prevention of hospital readmission and emergency department (ED) utilization will be a crucial strategy in reducing health care costs. There has been limited research on nurse assessment and patient perceptions of discharge readiness in relation to postdischarge outcomes. Objectives:To investigate the association of nurse and patient assessments of discharge readiness with postdischarge readmissions and ED visits. Research Design:Hierarchical regression analysis of readmission or ED utilization using independent nurse and patient assessments of discharge readiness and patient characteristics as explanatory variables, with hospital and unit fixed effects. Subjects:A total of 162 adult medical-surgical patients and their discharging nurses from 13 medical-surgical units of 4 Midwestern hospitals. Measures:Readiness for Hospital Discharge Scale completed independently by patients and their discharging nurses within 4 hours before hospital discharge; Postdischarge utilization (unplanned readmission or ED visit within 30 days postdischarge). Results:Correlations between nurse assessment and patient perceptions of discharge readiness were low (r = 0.15–0.32). Nurses rated patient readiness higher than patients themselves. Controlling for patient characteristics, nurse readiness for hospital discharge scale score (odds ratio = 0.57, P = 0.05) but not patient readiness for hospital discharge scale score was associated with postdischarge utilization. Conclusions:Nurse assessment was more strongly associated with postdischarge utilization than patient self-assessment. Formalizing nurse assessment of discharge readiness could facilitate identification of patients at risk for readmission or ED utilization before discharge when anticipatory interventions could prevent avoidable postdischarge utilization.

How ready are they? Parents of pediatric solid organ transplant recipients and the transition from hospital to home following transplant

Background:Higher proportions of BSN-educated nurses were associated with improved outcomes in hospital-level studies. A recent Institute of Medicine report calls for increasing the proportion of BSN-educated nurses to 80% by 2020. Patient-level evidence of cost and quality implications of the 80% BSN threshold is needed for a business case to support these efforts. Objectives:To conduct the economic analysis of meeting the 80% BSN threshold on patient outcomes and costs, using linked patient-nurse data. Research Design:Retrospective observational patient-level analysis of electronic data. Linear and logistic regression modeling with patient controls and diagnosis and unit fixed effects. Subjects:A total of 8526 adult medical-surgical patients matched with 1477 direct care nurses from an Eastern US academic medical center, during June 1, 2011–December 31, 2011. Measures:Outcomes include hospital mortality, all-cause same-facility 30-day readmission, length-of-stay, and total hospitalization cost. BSN proportion is a continuous measure for the proportion of nurse assessment inputs into the patient’s electronic medical record made by BSN-educated nurses; a dichotomous indicator for BSN proportion is 0.8–1.0. Results:Continuous BSN proportion was associated with lower mortality (OR=0.891, P<0.01). Compared with patients with <80% BSN care, patients receiving ≥80% of care from BSN nurses had lower odds of readmission (OR=0.813, P=0.04) and 1.9% shorter length-of-stay (P=0.03). Economic simulations support a strong business case for increasing the proportion of BSN-educated nurses to 80%. Conclusions:A combined approach of increasing the hospital-level BSN proportion to 80% and assuring a high BSN dose through individual patient-level staffing assignments is needed to achieve projected quality and costs benefits.

Patient Perceptions of Patient-Empowering Nurse Behaviours, Patient Activation and Functional Health Status in Postsurgical Patients with Life-Threatening Long-Term Illnesses

Adults aged 65 and older account for one third of all hospitalizations in the United States.(1) Almost one fifth (19.6%) of Medicare beneficiaries discharged from an acute care hospital are readmitted within 30 days.(2) High readmission rates have been attributed to inadequate discharge preparation, lack of patient and family caregiver readiness, poor discharge transition coordination, and unsuccessful coping with the demands of daily living.(3-9) Discharge needs may be different for older adults than for the general population because of the increased likelihood of multiple comorbidities, illness-induced limitations, impaired mobility, fatigue, anxiety, cognitive impairment, hearing impairments, health literacy deficits, and living alone.(7,8,10-12) The purpose of this study was to investigate differences in perceptions of the quality of discharge teaching and readiness for hospital discharge and their relationship to postdischarge utilization of emergency department (ED) visits and readmissions across the older adult age spectrum. Of particular interest is the applicability of quality of discharge teaching and discharge readiness assessment tools for the older adult population.

Validation of Patient and Nurse Short Forms of the Readiness for Hospital Discharge Scale and Their Relationship to Return to the Hospital

Lerret SM, Weiss ME. How ready are they? Parents of pediatric solid organ transplant recipients and the transition from hospital to home following transplant.
Pediatr Transplantation 2011: 15: 606–616.

Coping Difficulties After Hospitalization

AIM To explore the trajectory of associations between the nursing care process of patient empowerment during postsurgical hospitalization and postdischarge patient self-management outcomes, specifically patient activation and functional health status. BACKGROUND Patient-centred care models advocate for patient empowerment in long-term illness care. Postsurgical patients with life-threatening long-term illnesses frequently feel powerless, have unmet needs, decreased functional health status and high readmission rates; however, previous studies of patient empowerment have conceptualized empowerment as an outcome primarily in outpatient settings, with little attention paid to provider processes used to empower patients during hospitalizations. DESIGN A non-experimental, prospective, correlational study. METHODS This sample consisted of 113 postsurgical cancer and cardiac patients enrolled between August 2012–February 2013. Patient perceptions of patient-empowering nurse behaviours and baseline patient activation were measured prior to discharge. Patient activation and functional health status were measured 6 weeks following discharge. Data were analysed with multiple linear regression using a simultaneous equation approach. RESULTS Patients reported high perceptions of patient-empowering nurse behaviours and patient activation levels. Functional health status scores were below population norms. Patient perceptions of empowering nurse behaviours were positively associated with postdischarge patient activation, which was positively associated with mental functional health status. Length of stay was the only significant predictor of physical functional health status. CONCLUSION This study provides further quantitative evidence supporting the relationship between quality nursing care and postdischarge patient outcomes. Intentional use of patient-empowering nurse behaviours could lead to improved patient activation and functional health status in postsurgical patients with life-threatening long-term illnesses.