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Hospital-Level Nursing Resources and Equity in Surgical Care: Evidence From Medicaid-Insured Adults With Serious Mental Illness
Hospital-Level Nursing Resources and Equity in Surgical Care: Evidence From Medicaid-Insured Adults With Serious Mental Illness
상세정보
- 자료유형
- 학위논문 서양
- 최종처리일시
- 20260202104830
- ISBN
- 9798293803767
- DDC
- 610.73
- 서명/저자
- Hospital-Level Nursing Resources and Equity in Surgical Care: Evidence From Medicaid-Insured Adults With Serious Mental Illness
- 발행사항
- [Sl] : University of Pennsylvania, 2025
- 발행사항
- Ann Arbor : ProQuest Dissertations & Theses, 2025
- 형태사항
- 187 p
- 주기사항
- Source: Dissertations Abstracts International, Volume: 87-03, Section: A.
- 주기사항
- Advisor: Brooks Carthon, J. Margo.
- 학위논문주기
- Thesis (Ph.D.)--University of Pennsylvania, 2025.
- 초록/해제
- 요약Serious mental illness (SMI) affects approximately 14.1 million U.S. adults and is linked to elevated surgical risks, longer hospital stays (LOS), and higher readmission rates. For Medicaid-insured individuals with SMI these risks are exacerbated by limited access to high-quality care and socioeconomic disadvantage, which may worsen postsurgical outcomes. Despite these concerns, no studies have specifically examined whether Medicaid-insured patients with SMI face higher risks for postsurgical mortality, 30-day readmissions and longer LOS than those insured by other payers. Additionally, despite strong evidence that the quality of nursing care affects postsurgical outcomes, no studies have explored how nursing resources may influence insurance-related postsurgical disparities. The purpose of this study was to address these gaps through a systematic review of existing evidence on healthcare utilization among Medicaidinsured adults with SMI and an examination of how variations in nursing resources influence insurance-related disparities in postsurgical outcomes for patients with SMI. The first paper presents a systematic review of healthcare utilization among Medicaid-insured adults with SMI, highlighting high hospital use and poor access to mental health services, with little attention to nursing interventions. The second and third papers analyze cross-sectional data from 2015-2016 across four states and over 220,000 surgical patients to examine how nurse education and staffing impact postsurgical outcomes. Findings show that a 10% increase in BSN-prepared nurses is linked to an 8% reduction in 30-day readmissions, with greater benefits for Medicaidinsured patients. Overall, a higher proportion of BSN nurses was also associated with shorter in LOS. However, for Medicaid patients, poor staffing and low nurse education were linked to shorter LOS-raising concerns about premature discharge. These results challenge the assumption that shorter LOS is always beneficial and highlight the need to interpret LOS in the context of nursing quality and patient complexity. Overall, this dissertation emphasizes the critical role of nursing resources in reducing disparities for Medicaid-insured surgical patients with SMI and supports policies to improve nurse education and staffing to enhance equity in surgical outcomes.
- 일반주제명
- Nursing
- 일반주제명
- Medicine
- 일반주제명
- Health education
- 일반주제명
- Mental health
- 키워드
- Health equity
- 키워드
- Medicaid
- 키워드
- Nurse education
- 기타저자
- University of Pennsylvania Nursing
- 기본자료저록
- Dissertations Abstracts International. 87-03A.
- 전자적 위치 및 접속
- 로그인 후 원문을 볼 수 있습니다.
MARC
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■006m o d
■007cr#unu||||||||
■020 ▼a9798293803767
■035 ▼a(MiAaPQ)AAI32170405
■040 ▼aMiAaPQ▼cMiAaPQ
■0820 ▼a610.73
■1001 ▼aLangston, Christine.
■24510▼aHospital-Level Nursing Resources and Equity in Surgical Care: Evidence From Medicaid-Insured Adults With Serious Mental Illness
■260 ▼a[Sl]▼bUniversity of Pennsylvania▼c2025
■260 1▼aAnn Arbor▼bProQuest Dissertations & Theses▼c2025
■300 ▼a187 p
■500 ▼aSource: Dissertations Abstracts International, Volume: 87-03, Section: A.
■500 ▼aAdvisor: Brooks Carthon, J. Margo.
■5021 ▼aThesis (Ph.D.)--University of Pennsylvania, 2025.
■520 ▼aSerious mental illness (SMI) affects approximately 14.1 million U.S. adults and is linked to elevated surgical risks, longer hospital stays (LOS), and higher readmission rates. For Medicaid-insured individuals with SMI these risks are exacerbated by limited access to high-quality care and socioeconomic disadvantage, which may worsen postsurgical outcomes. Despite these concerns, no studies have specifically examined whether Medicaid-insured patients with SMI face higher risks for postsurgical mortality, 30-day readmissions and longer LOS than those insured by other payers. Additionally, despite strong evidence that the quality of nursing care affects postsurgical outcomes, no studies have explored how nursing resources may influence insurance-related postsurgical disparities. The purpose of this study was to address these gaps through a systematic review of existing evidence on healthcare utilization among Medicaidinsured adults with SMI and an examination of how variations in nursing resources influence insurance-related disparities in postsurgical outcomes for patients with SMI. The first paper presents a systematic review of healthcare utilization among Medicaid-insured adults with SMI, highlighting high hospital use and poor access to mental health services, with little attention to nursing interventions. The second and third papers analyze cross-sectional data from 2015-2016 across four states and over 220,000 surgical patients to examine how nurse education and staffing impact postsurgical outcomes. Findings show that a 10% increase in BSN-prepared nurses is linked to an 8% reduction in 30-day readmissions, with greater benefits for Medicaidinsured patients. Overall, a higher proportion of BSN nurses was also associated with shorter in LOS. However, for Medicaid patients, poor staffing and low nurse education were linked to shorter LOS-raising concerns about premature discharge. These results challenge the assumption that shorter LOS is always beneficial and highlight the need to interpret LOS in the context of nursing quality and patient complexity. Overall, this dissertation emphasizes the critical role of nursing resources in reducing disparities for Medicaid-insured surgical patients with SMI and supports policies to improve nurse education and staffing to enhance equity in surgical outcomes.
■590 ▼aSchool code: 0175.
■650 4▼aNursing
■650 4▼aMedicine
■650 4▼aHealth education
■650 4▼aMental health
■653 ▼aHealth disparities
■653 ▼aHealth equity
■653 ▼aMedicaid
■653 ▼aNurse education
■653 ▼aNursing resources
■653 ▼aSerious mental illness
■690 ▼a0569
■690 ▼a0564
■690 ▼a0347
■690 ▼a0769
■690 ▼a0680
■71020▼aUniversity of Pennsylvania▼bNursing.
■7730 ▼tDissertations Abstracts International▼g87-03A.
■790 ▼a0175
■791 ▼aPh.D.
■792 ▼a2025
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T17359069▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
