Hospital-Level Nurse Communication and 30-Day Readmission in United States Acute Care Hospitals: A Cross-Sectional Centers for Medicare and Medicaid Services Hospital Compare Analysis

Background: Nurse–patient communication is a nurse-associated, interprofessionally delivered care-process indicator captured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), but its hospital-level association with hospital-wide readmission after structural and case-mix adjustment remains incompletely characterized. Methods: We conducted a cross-sectional secondary analysis of publicly available Centers for Medicare and Medicaid Services (CMS) Hospital Compare data. The exposure was the HCAHPS nurse communication composite (April 2024–March 2025), and the outcome was the Hybrid Hospital-Wide All-Cause 30-day Readmission measure (July 2023–June 2024). The primary model adjusted for ownership and US Census region. Robustness was assessed using a six-model hierarchy, including linkage to Provider of Services and HCRIS data to account for teaching intensity, staffing density, and Disproportionate Share Hospital percentage. Additional sensitivity analyses examined survey weighting, survey-volume restriction, lagged HCAHPS scores, HCAHPS-domain specificity, CMS star-rating adjustment, non-linearity, regional interaction, health-system clustering, and alternative functional forms. Findings are interpreted as cross-sectional ecological associations, not causal or predictive effects. Results: Among 2844 acute care hospitals, each 10-percentage-point higher patient-perceived nurse communication score was associated with a 0.289 percentage-point lower 30-day readmission rate (95% CI −0.341 to −0.236; p < 0.001) in the primary model. The association was consistent across sensitivity analyses, although it was attenuated after additional adjustment for linked structural hospital characteristics. Among HCAHPS domains, discharge information showed the largest association with readmission. These findings indicate a modest but consistent hospital-level association rather than evidence of causality. Conclusions: Hospitals with higher patient-perceived nurse communication tended to have lower 30-day readmission rates, although the association was attenuated after adjustment for structural hospital characteristics. Patient-perceived nurse communication may therefore be a useful nurse-associated process indicator for readmission-related benchmarking, although it reflects interprofessional care and residual organizational confounding remains plausible. Longitudinal or interventional studies are needed to determine whether improving nurse communication can reduce readmissions.