Organizational Factors and Hospital Readmission Reduction in Older Adults: A Multi-Hospital Panel Analysis of Geriatric Nursing Education, Health Information Technology, and Interprofessional Care Models

• Multidimensional Model : Five hospital organizational factors (geriatric nursing education, health IT maturity, telehealth, interprofessional care, nurse staffing) independently reduce Medicare readmission risk. • Panel Evidence : 2,850 hospitals, 11-year design (N=17,100 hospital-years) with fixed-effects regression controls selection bias rigorous policy translation. • Equity Focus: Protective effects largest in high-complexity hospitals and socioeconomically disadvantaged communities’ simultaneous quality and disparity reduction. • Actionable Levers: Identifies measurable organizational investments hospital leadership can implement immediately to control readmission outcomes. • Policy Bridge : Establishes organizational capacity as binding constraint, justifying parallel hospital and social-policy investments for impact. Healthcare system organizational capacity not demographic aging alone determines hospital readmission risk among older adults. Evidence-based geriatric care frameworks remain incompletely integrated into routine hospital practice despite demonstrated effectiveness. To quantify independent and joint associations between five modifiable hospital organizational factors (geriatric nursing education intensity, health IT maturity, telehealth adoption, interprofessional geriatric care models, nurse staffing) and risk-adjusted 30-day readmission rates (RARR65) for Medicare beneficiaries aged 65+, accounting for contextual moderators including case-mix severity, social deprivation, and rurality. Panel analysis of 2,850 U.S. acute-care hospitals (2014-2024; N = 17,100 hospital-years) using hospital fixed-effects regression with three-way interaction terms. Data sources: CMS Hospital Compare, AHRQ HCUP, ANCC Certification Registry, and HIMSS EMRAM assessments. All five organizational factors independently predicted lower readmission rates (p < .01). Geriatric nursing education intensity (p < .001); health IT maturity (p = .002); telehealth adoption (p = .011); interprofessional geriatric models (p = .004); nurse staffing (p < .001). Moderation analyses revealed amplified protective effects in high-complexity hospitals (GNEI × case-mix severity p = .015) and socioeconomically disadvantaged areas (HITM × social deprivation (p = .009). Nurse staffing demonstrated the largest effect size (standardized effect per SD: -0.61 percentage points). Multidimensional organizational approaches integrating nursing specialization, technological maturity, telehealth infrastructure, care model redesign, and adequate staffing significantly reduce preventable hospital readmissions. Protective effects are concentrated in highest-need populations, offering simultaneous opportunities for quality improvement and disparity reduction. Hospital-level interventions are necessary but insufficient; parallel policy-level investments in social determinants are essential to maximize effectiveness.