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Nurse Practitioner Care Environments and Racial and Ethnic Disparities in Hospitalization Among Medicare Beneficiaries with Coronary Heart Disease

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Abstract

Background

Nurse practitioners care for patients with cardiovascular disease, particularly those from racial and ethnic minority groups, and can help assure equitable health outcomes. Yet, nurse practitioners practice in challenging care environments, which limits their ability to care for patients.

Objective

To determine whether primary care nurse practitioner care environments are associated with racial and ethnic disparities in hospitalizations among older adults with coronary heart disease.

Design

In this observational study, a cross-sectional survey was conducted among primary care nurse practitioners in 2018–2019 who completed a valid measure of care environment. The data was merged with 2018 Medicare claims data for patients with coronary heart disease.

Participants

A total of 1244 primary care nurse practitioners and 180,216 Medicare beneficiaries 65 and older with coronary heart disease were included.

Main Measures

All-cause and ambulatory care sensitive condition hospitalizations in 2018.

Key Results

There were 50,233 hospitalizations, 9068 for ambulatory care sensitive conditions. About 28% of patients had at least one hospitalization. Hospitalizations varied by race, being highest among Black patients (33.5%). Care environment moderated the relationship between race (Black versus White) and hospitalization (OR 0.93; 95% CI, 0.88–0.98). The lowest care environment was associated with greater hospitalization among Black (odds ratio=1.34; 95% CI, 1.20–1.49) compared to White beneficiaries. Practices with the highest care environment had no racial differences in hospitalizations. There was no interaction effect between care environment and race for ambulatory care sensitive condition hospitalizations. Nurse practitioner care environment had a protective effect on these hospitalizations (OR, 0.96; 95% CI, 0.92–0.99) for all beneficiaries.

Conclusions

Unfavorable care environments were associated with higher hospitalization rates among Black than among White beneficiaries with coronary heart disease. Racial disparities in hospitalization rates were not detected in practices with high-quality care environments, suggesting that improving nurse practitioner care environments could reduce racial disparities in hospitalizations.

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Funding

The National Institute on Minority Health and Health Disparities (R01 MD011514).

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Authors and Affiliations

  1. School of Nursing, Columbia University, 560 West 168th Street, Office 624, New York, NY, 10032, USA

    Lusine Poghosyan PhD, Jianfang Liu PhD & Kathleen Flandrick DrPH

  2. Mailman School of Public Health, Columbia University, New York, USA

    Lusine Poghosyan PhD

  3. School of Medicine, Yale University, New Haven, CT, USA

    Erica Spatz MD

  4. College of Nursing and Public Health, Adelphi University, Garden City, NY, USA

    Zainab Osakwe PhD

  5. School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA

    Grant R. Martsolf PhD

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  1. Lusine Poghosyan PhD
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Poghosyan, L., Liu, J., Spatz, E. et al. Nurse Practitioner Care Environments and Racial and Ethnic Disparities in Hospitalization Among Medicare Beneficiaries with Coronary Heart Disease. J GEN INTERN MED 39, 61–68 (2024). https://doi.org/10.1007/s11606-023-08367-1

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