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Transitional Care, Neighborhood Disadvantage, and Heart Failure Hospital Readmission: A Moderated Mediation Analysis

Distelhorst, Karen S.
http://orcid.org/0000-0003-3924-8401
http://rave.ohiolink.edu/etdc/view?acc_num=kent158613074205556

Abstract Details

2020, PHD, Kent State University, College of Nursing.
Between 18.5% and 21% of patients hospitalized for heart failure (HF) are readmitted within 30 days, representing a significant burden to the U.S. healthcare system. Readmission within 30-days has been considered an issue of poor quality of care by CMS, but for patients it may indicate the worsening of the disease process or difficulty managing their HF and other comorbidities. Further, disparities are known to exist for HF and HF hospital readmission for patients living in highly disadvantaged neighborhoods. Multidisciplinary interventions that account for care across health care settings, as well as the upstream factors that impact health overall, are needed to improve outcomes. The purpose of this study was to examine the relationship between early provider follow-up, nursing care coordination/transition management (CCTM) intensity, and 30-day hospital readmission in a population of older adults with HF, and to determine if an interaction exists with neighborhood disadvantage. The study was a retrospective, correlational design utilizing existing data. Inclusion criteria were age ≥ 65 years, hospitalization for heart failure, and discharge to the home setting. In the primary study, population-level data were obtained based on the geocoded addresses of record from the index admissions. All other data were obtained from medical records and billing databases. Logistic regression and moderated mediation analysis were used to describe the relationships between the study variables. A direct relationship between early provider follow-up within 14 days and decreased 30-day readmission was identified, but no indirect relationship through CCTM intensity. Further, neighborhood disadvantage did not moderate the direct effect of early provider follow-up on 30-day readmission. The relationship between early provider follow-up and CCTM intensity was significant and moderated by neighborhood disadvantage. Patients who had an early provider follow-up and lived in areas of low to moderate neighborhood disadvantage had more CCTM contacts. For this study population, current transitional care interventions may not be reaching patients living in the most disadvantaged neighborhoods. Future prospective studies should examine the combined effect of CCTM and provider follow-up, with standardized CCTM processes and interventions aimed to reach the most disadvantaged population.
Dana Hansen, PhD (Committee Chair)
Lisa Onesko, DNP (Committee Member)
Amy Petrinec, PhD (Committee Member)
Lynette Phillips, PhD (Committee Member)
Hallam Jeffrey, PhD (Other)
127 p.
Health Care; Health Sciences; Nursing
Nursing; Population health; heart failure; hospital readmission; care coordination; transitional care; upstream factors; neighborhood disadvantage

Recommended Citations

Citations

  • Distelhorst, K. S. (2020). Transitional Care, Neighborhood Disadvantage, and Heart Failure Hospital Readmission: A Moderated Mediation Analysis [Doctoral dissertation, Kent State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=kent158613074205556

    APA Style (7th edition)

  • Distelhorst, Karen. Transitional Care, Neighborhood Disadvantage, and Heart Failure Hospital Readmission: A Moderated Mediation Analysis. 2020. Kent State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=kent158613074205556.

    MLA Style (8th edition)

  • Distelhorst, Karen. "Transitional Care, Neighborhood Disadvantage, and Heart Failure Hospital Readmission: A Moderated Mediation Analysis." Doctoral dissertation, Kent State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=kent158613074205556

    Chicago Manual of Style (17th edition)

kent158613074205556
369
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This open access ETD is published by Kent State University and OhioLINK.