Association between nursing care delivery models and patients' health outcomes in a university hospital: A retrospective cohort study based on the Diagnostic Procedure Combination database

Abstract

Aim This study aims to examine the association between nursing delivery models (fixed‐team nursing model and Partnership Nursing System® [PNS®]) and patients' health outcomes (30‐day in‐hospital mortality and functional decline, indicated by a decline in Barthel Index or in‐hospital mortality). Methods This study used a retrospective cohort design based on the data from the Diagnostic Procedure Combination database, which included routinely collected health data for Japanese administrative claims. Participants were inpatients aged 20–99 years admitted between July 2010 and August 2012 (fixed‐team nursing period) and July 2014 and August 2017 (PNS® period) to an academic teaching hospital in Japan. Odds ratios and 95% confidence intervals were estimated using multivariable logistic models. Results We included 24,108 and 23,872 patients for the analyses of 30‐day in‐hospital mortality and functional decline, respectively (median age: 62 years; 52% women). The 30‐day mortalities in both fixed‐team nursing and PNS® groups were 0.5%. There was no significant association between the nursing delivery models and 30‐day in‐hospital mortality (adjusted odds ratio = 1.15, 95% confidence interval = 0.78–1.70). However, the PNS® group was found to have a higher proportion of patients with functional decline (2.7%) than the fixed‐team nursing group (2.2%; p = .030). The adjusted odds ratio of declined function in the PNS® group, compared to the fixed‐team nursing group, was 1.40 (95% confidence interval = 1.17–1.68, p < .001). Conclusions Further studies are needed to examine how the PNS® model influences patient outcomes, especially nurse‐sensitive patient outcomes.

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