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76 QUALITY IMPROVEMENT & MEASUREMENT Nurses' work environments affect patient outcomes, study finds By Mackenzie Bean T he state of a nurse's work environment can affect nurs- ing care quality, job satisfaction and patient outcomes, according to a study published in Medical Care. Researchers from the University of Pennsylvania School of Nursing's Center for Health Outcomes & Policy Research in Philadelphia conducted the study. They reviewed 16 years' worth of studies to investigate the relationship between nurse work environment and the following factors: nurse job out- comes, nurse assessments of quality and safety, patient health outcomes, and patient satisfaction. After reviewing 309 research articles, researchers narrowed their analysis down to 17 articles reporting data from 2,677 hospitals, 141 nursing units, 165,024 nurses and 1,368,420 patients across 22 countries. Researchers found better work environments were linked to lower odds of negative nurse outcomes, poor safety or quality ratings, and negative patient outcomes. A positive work environment was also linked to higher odds of patient satisfaction. "Our results support the unique status of the nurse work environment as a foundation for both patient and provid- er well-being that warrants the resources and attention of healthcare administrators," lead author Eileen Lake, PhD, MSN, a professor of nursing at Penn and associate director of CHOPR, said in a press release. n 100+ hospitals have childbirth complication rates 2 times above norm, USA Today investigation finds By Mackenzie Bean A t least 120 hospitals nationwide have child- birth complication rates that are two times higher than other hospitals, according to an investigative report from USA Today. Three things to know: 1. USA Today reviewed billing data from 13 states to identify severe childbirth complications among 7 million births between 2014-17. The publication cal- culated complication rates for 1,027 hospitals using a CDC-developed formula. 2. Most hospitals had childbirth complication rates of less than 1.5 percent. However, 120 hospitals — about 1 in 8 included in the analysis — had compli- cation rates two times that of a typical hospital, USA Today found. 3. The 120 hospitals vary in type, size and location. Some treat a predominantly low-income patient pop- ulation where women lack regular access to prenatal care and come to the hospital with existing medical conditions. However, others are community hospitals in areas where routine births are common. n Accounting for social risk factors can help safety-net hospitals avoid readmission penalties By Anuja Vaidya S ocial risk factors, such as poverty, can affect readmissions to safety-net hos- pitals, thereby affecting federal pen- alties for readmission rates, according to a study published in Health Services Research. CMS' Hospital Readmissions Reduction Program places financial penalties on hospi- tals with high readmission rates. Safety-net hospitals, which provide care regardless of a patient's ability to pay, tend to be at the receiving end of those penalties, as the pro- gram's current performance model does not account for social risk factors. Researchers from Detroit-based Henry Ford Health System created a risk adjustment model that incorporates social risk factors. ey studied claims data for nearly 3 million fee-for-service Medicare patients who were hospitalized for heart attack, congestive heart failure or pneumonia from December 2012 to November 2015. They found social risk factors, including poverty, disability and living in a disad- vantaged neighborhood, were associated with higher readmissions in all three medical conditions. However, when the risk adjustment model incorporated social risk factors, safety-net hospitals saw a significant decrease in read- missions rates for all three medical condi- tions compared to their counterparts that are more affluent. Researchers estimated that safety-net hos- pitals would see a 21.8 percent reduction in penalties, or around $17 million, if their risk adjustment model was used. Meanwhile, affluent hospitals would see a 22 percent increase in penalties. n