Tags

Type your tag names separated by a space and hit enter

Impact of patient-level risk adjustment on the findings about nurse staffing and 30-day mortality in veterans affairs acute care hospitals.
Nurs Res. 2013 Jul-Aug; 62(4):226-32.NR

Abstract

BACKGROUND

Studies about nurse staffing and patient outcomes often lack adequate risk adjustment because of limited access to patient information.

OBJECTIVE

The aim of this study was to examine the impact of patient-level risk adjustment on the associations of unit-level nurse staffing and 30-day inpatient mortality.

METHODS

This retrospective cross-sectional study included 284,097 patients discharged during 2007-2008 from 446 acute care nursing units at 128 Veterans Affairs medical centers. The association of nurse staffing with 30-day mortality was assessed using hierarchical logistic models under three levels of risk-adjustment conditions: using no patient information (low), using patient demographics and diagnoses (moderate), or using patient demographics and diagnoses plus physiological measures (high).

RESULTS

Discriminability of the models improved as the level of risk adjustment increased. The c-statistics for models of low, moderate, and high risk adjustment were 0.64, 0.74, and 0.88 for non-ICU patients and 0.66, 0.76, and 0.88 for ICU patients. For non-ICU patients, higher RN skill mix was associated with lower 30-day mortality across all three levels of risk adjustment. For ICU patients, higher total nursing hours per patient day was strongly associated with higher mortality with moderate risk adjustment (p = .0002), but this counterintuitive association was not significant with low or high risk adjustment.

DISCUSSION

Inadequate risk adjustment may lead to biased estimates about nurse staffing and patient outcomes. Combining physiological measures with commonly used administrative data is a promising risk-adjustment approach to reduce potential biases.

Authors+Show Affiliations

Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA. jhe@kumc.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

23817280

Citation

He, Jianghua, et al. "Impact of Patient-level Risk Adjustment On the Findings About Nurse Staffing and 30-day Mortality in Veterans Affairs Acute Care Hospitals." Nursing Research, vol. 62, no. 4, 2013, pp. 226-32.
He J, Almenoff PL, Keighley J, et al. Impact of patient-level risk adjustment on the findings about nurse staffing and 30-day mortality in veterans affairs acute care hospitals. Nurs Res. 2013;62(4):226-32.
He, J., Almenoff, P. L., Keighley, J., & Li, Y. F. (2013). Impact of patient-level risk adjustment on the findings about nurse staffing and 30-day mortality in veterans affairs acute care hospitals. Nursing Research, 62(4), 226-32. https://doi.org/10.1097/NNR.0b013e318295810c
He J, et al. Impact of Patient-level Risk Adjustment On the Findings About Nurse Staffing and 30-day Mortality in Veterans Affairs Acute Care Hospitals. Nurs Res. 2013 Jul-Aug;62(4):226-32. PubMed PMID: 23817280.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of patient-level risk adjustment on the findings about nurse staffing and 30-day mortality in veterans affairs acute care hospitals. AU - He,Jianghua, AU - Almenoff,Peter L, AU - Keighley,John, AU - Li,Yu-Fang, PY - 2013/7/3/entrez PY - 2013/7/3/pubmed PY - 2013/9/6/medline SP - 226 EP - 32 JF - Nursing research JO - Nurs Res VL - 62 IS - 4 N2 - BACKGROUND: Studies about nurse staffing and patient outcomes often lack adequate risk adjustment because of limited access to patient information. OBJECTIVE: The aim of this study was to examine the impact of patient-level risk adjustment on the associations of unit-level nurse staffing and 30-day inpatient mortality. METHODS: This retrospective cross-sectional study included 284,097 patients discharged during 2007-2008 from 446 acute care nursing units at 128 Veterans Affairs medical centers. The association of nurse staffing with 30-day mortality was assessed using hierarchical logistic models under three levels of risk-adjustment conditions: using no patient information (low), using patient demographics and diagnoses (moderate), or using patient demographics and diagnoses plus physiological measures (high). RESULTS: Discriminability of the models improved as the level of risk adjustment increased. The c-statistics for models of low, moderate, and high risk adjustment were 0.64, 0.74, and 0.88 for non-ICU patients and 0.66, 0.76, and 0.88 for ICU patients. For non-ICU patients, higher RN skill mix was associated with lower 30-day mortality across all three levels of risk adjustment. For ICU patients, higher total nursing hours per patient day was strongly associated with higher mortality with moderate risk adjustment (p = .0002), but this counterintuitive association was not significant with low or high risk adjustment. DISCUSSION: Inadequate risk adjustment may lead to biased estimates about nurse staffing and patient outcomes. Combining physiological measures with commonly used administrative data is a promising risk-adjustment approach to reduce potential biases. SN - 1538-9847 UR - https://www.unboundmedicine.com/medline/citation/23817280/Impact_of_patient_level_risk_adjustment_on_the_findings_about_nurse_staffing_and_30_day_mortality_in_veterans_affairs_acute_care_hospitals_ L2 - https://doi.org/10.1097/NNR.0b013e318295810c DB - PRIME DP - Unbound Medicine ER -