Longitudinal Analyses of the Association of Nurse Staffing and Patient Outcomes for U.S. Acute Care Hospitals

• Activity Number: 34
• Type: Contributed
• Date/Time: Sunday, August 3, 2014 : 2:00 PM to 3:50 PM
• Sponsor: Health Policy Statistics Section
• Author(s): Jianghua He*+ and Vincent Staggs and Sandra Bergquist-Beringer and Nancy Dunton
• Companies: Kansas University Medical Center and University of Kansas Medical Center and University of Kansas Medical Center and University of Kansas Medical Center
• Keywords: patient care ; nursing quality ; random variations ; aggregated data

Abstract

Most studies in the literature about nurse staffing and patient outcomes have been based on cross-sectional analyses, and the results of these studies are controversial. We extracted quarterly unit-level nursing-related health care data in 2004-2012 from the National Database of Nursing Quality Indicators® (NDNQI®). Unit-level analyses using hierarchical generalized linear modeling did not identify any consistent longitudinal association between nurse staffing variables and nursing-sensitive patient outcomes such as total inpatient falls and hospital acquired pressure ulcers. Further examinations showed that the associations of nurse staffing and patient outcomes at unit-level were not identifiable due to the large variations of staffing variables and patient outcomes at the unit level. Analyses based on aggregated data across hospitals and units found consistent associations of nurse staffing and patient outcomes, both at the overall time trend and seasonality levels. The comparison between the unit-level analyses and aggregated analyses suggests that the aggregation reduced the variation in the staffing and outcome variables so that their associations became detectable.