Evaluating the Costs and Outcomes of Hospital Nursing Resources: a Matched Cohort Study of Patients with Common Medical
- PDF / 269,973 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 99 Downloads / 215 Views
Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; 2The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; 3Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA; 4Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA; 5Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA, USA; 6The Departments of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; 7Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; 8Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
BACKGROUND: Nursing resources, such as staffing ratios and skill mix, vary across hospitals. Better nursing resources have been linked to better patient outcomes but are assumed to increase costs. The value of investments in nursing resources, in terms of clinical benefits relative to costs, is unclear. OBJECTIVE: To determine whether there are differential clinical outcomes, costs, and value among medical patients at hospitals characterized by better or worse nursing resources. DESIGN: Matched cohort study of patients in 306 acute care hospitals. PATIENTS: A total of 74,045 matched pairs of fee-forservice Medicare beneficiaries admitted for common medical conditions (25,446 sepsis pairs; 16,332 congestive heart failure pairs; 12,811 pneumonia pairs; 10,598 stroke pairs; 8858 acute myocardial infarction pairs). Patients were also matched on hospital size, technology, and teaching status. MAIN MEASURES: Better (n = 76) and worse (n = 230) nursing resourced hospitals were defined by patient-tonurse ratios, skill mix, proportions of bachelors-degree nurses, and nurse work environments. Outcomes included 30-day mortality, readmission, and resource utilization-based costs. KEY RESULTS: Patients in hospitals with better nursing resources had significantly lower 30-day mortality (16.1% vs 17.1%, p < 0.0001) and fewer readmissions (32.3% vs 33.6%, p < 0.0001) yet costs were not significantly different ($18,848 vs 18,671, p = 0.133). The greatest outcomes
Prior presentations This study was accepted for presentation at the Annual Research Meeting of AcademyHealth on June 16, 2020, but the presentation was cancelled due to COVID-19. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06151-z) contains supplementary material, which is available to authorized users. Received July 24, 2020 Accepted August 12, 2020
and cost advantage of better nursing resourced hospitals were in patients with sepsis who had lower mortality (25.3% vs 27.6%, p < 0.0001). Overall, patients with the highest risk of mortality on admission experienced the greatest reductions in mortality and readmission from better nursing at no difference in cost. CONCLUSIONS: Medicare benefic
Data Loading...
