The Project aims to determine whether outcomes for patients with AD are better when they are cared for in hospitals with better nursing resources (patient-to-nurse staffing ratios, skill mix, nurses’ education, and the quality of the work environment). We expect to confirm that outcomes are worse for patients with AD than for similar patients without AD. However, patients with AD will fare better when cared for in hospitals with better nursing resources. It also aims to determine whether racial and ethnic disparities in AD outcomes are narrowed in hospitals with better nursing resources (patient-to-nurse staffing ratios, nurses’ education, skill mix, and the quality of the work environment). We expect to find that outcomes are worse for patients with AD who are minorities but the gap between minorities and non-minorities will be less in hospitals with better nursing resources.
Nursing is at the frontlines of managing the complex care and management of hospitalized patients with Alzheimer’s disease and dementia (AD). AD is a source of significant morbidity in the older adult population and results in disproportionately higher healthcare costs and rates of hospitalization.1-3 Management of any medical condition or surgical course of care is made more challenging in the presence of AD. A few examples of complicating factors include communication and comprehension difficulties between provider and patient, treatment adherence difficulties, complex medication regimens, more co-morbid conditions, physical safety concerns, behavioral challenges, and poor ambulatory care leading up to and following hospitalization.
The work that nurses do to manage the care of patients with AD and prevent complications during hospitalization can be time intensive and complex. A poorly organized nursing workforce is a systemic failure that can compromise patient safety. A robust literature base has linked organizational nursing work environment and staffing to patient outcomes including falls and pressure ulcers. Organizational system failures and impediments undermine nurses’ ability to carry out the complex surveillance and management required to maintain the safety of the hospitalized older adult patient with AD and can lead to errors, safety incidents, and poor outcomes. The growing number of older adults has the potential to magnify the burdens on nursing systems to care for patients with complex conditions such as AD.
Taking advantage of a unique and readily available multi-state survey of nurses representing over 600 hospitals coupled with Medicare patient claims data, we will examine the effect of the hospital nursing resources and work environments on outcomes for surgical patients with co-existing AD. This study will allow us to identify whether good nurse work environments are more important to ensuring good outcomes for patients with AD. The findings from this pilot will be used to develop a National Institutes of Health (specifically, the National Institute on Aging) grant proposal that would use data at multiple points in time in order to determine whether there is a causal case for hospitals to improve their nurse work environments over time to achieve improvements in outcomes for patients with AD.