Jacqueline Nikpour, PhD student, submitted a grant to the Robert Wood Johnson Foundation for her post-doc. It is a grant that is meant for RWJF Future of Nursing Scholars to attain supplemental funding to continue their research in their postdoctoral position. Her post-doc will be at the University of Pennsylvania.

Health-related social needs (HRSN) are responsible for up to 80% of health outcomes but often go unaddressed during a patient's hospitalization. Unmet HRSN are more common amongst Black patients and other racial and ethnic minorities (REM) and can lead to increased readmissions and ED utilization after discharge. Among patients with common chronic diseases, such as coronary artery disease (CAD), having one’s HRSN met is associated with lower risk of adverse outcomes, such as myocardial infarction and death. Despite the critical role of HRSN in driving patient outcomes, these needs are often unmet when a patient is hospitalized. Health care systems have few processes for addressing HRSN and may operate in silos from community-based providers and resources. Hospital clinicians often have competing demands that prevent them from addressing HRSN. As a result, patients with unmet HRSN — typically REM and of low SES — may not have the necessary resources to manage chronic conditions such as CAD upon discharge. This places these patients at a higher risk for readmissions and emergency department visits.

Registered nurses (RNs) and nurse practitioners (NPs) in primary care are optimally suited to address HRSN amongst recently discharged Black patients, and evidence exists that a diverse nursing workforce — including Black RNs and NPs — can improve outcomes among this population. However, these RNs & NPs may experience barriers such as limited time with patients to address patient needs, job dissatisfaction and a poor work environment, that are shown to negatively impact patient outcomes. The specific aims of this explanatory sequential mixed-methods proposal are to: 1.) determine if there are disparities in readmissions and ED utilization among Black and White Medicare beneficiaries with CAD who have been recently discharged, and examine if those disparities are due in part to: a.) the quality of the ambulatory practice environment, b.) provision of patient-centered care, or c.) higher levels of burnout, job dissatisfaction, and intent to leave among Black RNs and NPs working in primary care settings, and 2.) explore the complex patient, provider, and system-level factors that impact Black RNs and NPs ability to address HRSNs, particularly among Black patients and other REMs.

The postdoctoral scholar will be completing a T32 at the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing under the direction of Margo Brooks Carthon.