The relationship between nurse staffing levels and nursing-sensitive outcomes in hospitals: Assessing heterogeneity among unit and outcome types

Milstein, Ricarda; Schreyoegg, Jonas

doi:10.1016/j.healthpol.2020.07.013

Cited by 16 publications

(18 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We extract all full inpatient stays invoiced in line with the German DRG system between 2014 and 2018 from the data base. We exclude inpatient cases discharged from pediatric, psychiatric, or intensive care units because many NSPOs applied in adult acute care are not applicable to or have not been validated for these hospital units [ 30 , 35 ]. In addition, we exclude all unit types for which the prevalence rate for each of the NSPOs falls below one percent, as well as unit types that are present in fewer than 25 hospitals.…”

Section: Methodsmentioning

confidence: 99%

“…Even though these studies have found variation in the associations between nurse staffing levels and NPSOs across hospital units, they have still addressed only some of the endogeneity problem because of their reliance on small sample sizes and their rather coarse distinction between categories of hospital unit (e.g., between only medical and surgical units). To address this limitation, Milstein & Schreyögg [ 30 ] conducted a cross-sectional analysis of a large data set covering almost all hospital units in Germany from 2012 to 2014. Based on approximately 27 million inpatient cases stratified across 20 distinct unit types, they used ordinary least squares (OLS) regressions to analyze the link between nurse staffing levels and 11 NSPOs.…”

Section: Previous Literaturementioning

confidence: 99%

“…From a methodological perspective, the OLS regression model applied by Milstein & Schreyögg [ 30 ] corresponds to the design of the majority of studies in this field, which mainly use linear or logistic regression models [ 1 , 4 , 6 , 33 , 43 ]. So far, multilevel regression models have been employed only rarely even though they may have advantages in this context.…”

Section: Previous Literaturementioning

confidence: 99%

“…A further limitation of most previous studies is their failure to consider NSPOs that take place after discharge from hospital, such as readmissions [ 11 , 45 ]. Additionally, few studies to date have focused on the German market [ 4 , 30 ]. This is unfortunate given recent legislation mandating minimum nursing ratios in Germany and the need to support their development and implementation with evidence.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The impact of nurse staffing levels on nursing-sensitive patient outcomes: a multilevel regression approach

Dietermann¹,

Winter

Schneider

et al. 2021

Eur J Health Econ

View full text Add to dashboard Cite

The goal of this study is to provide empirical evidence of the impact of nurse staffing levels on seven nursing-sensitive patient outcomes (NSPOs) at the hospital unit level. Combining a very large set of claims data from a German health insurer with mandatory quality reports published by every hospital in Germany, our data set comprises approximately 3.2 million hospital stays in more than 900 hospitals over a period of 5 years. Accounting for the grouping structure of our data (i.e., patients grouped in unit types), we estimate cross-sectional, two-level generalized linear mixed models (GLMMs) with inpatient cases at level 1 and units types (e.g., internal medicine, geriatrics) at level 2. Our regressions yield 32 significant results in the expected direction. We find that differentiating between unit types using a multilevel regression approach and including postdischarge NSPOs adds important insights to our understanding of the relationship between nurse staffing levels and NSPOs. Extending our main model by categorizing inpatient cases according to their clinical complexity, we are able to rule out hidden effects beyond the level of unit types.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Previous Literaturementioning

confidence: 99%

Section: Previous Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The impact of nurse staffing levels on nursing-sensitive patient outcomes: a multilevel regression approach

Dietermann¹,

Winter

Schneider

et al. 2021

Eur J Health Econ

View full text Add to dashboard Cite

show abstract

“…Rate of falls in hospitalized patients represents a common and persistent problem influenced by different aspects, nursing care being one of them. As has been argued, measurement of nursing‐sensitive outcomes in hospital setting allows to identify their relationship with nursing staffing levels which would help to explain differences between hospitals, as well as between units levels, in Catalonia health care system (Eglseer et al., 2020; Milstein & Schreyoegg, 2020).…”

Section: Discussionmentioning

confidence: 99%

The experience of Catalonia measuring nurse‐sensitive indicators: Trends study 2012–2018

et al. 2021

View full text Add to dashboard Cite

Aim To describe nursing‐sensitive indicators measured in Catalonia. Background In Catalonia, since 2012, under the umbrella of the Results Centre, outcomes of every health care setting have been published and made open to health care professionals and citizens. Methods Trends study of nursing‐sensitive indicators was based on data collected systematically from each setting from 2012 to 2018. Percentages and rates were calculated for each of 14 indicators analysed from all primary care, hospitals and long‐term care centres. Results Percentage of population aged 60 years or older correctly vaccinated against flu has been decreasing, while percentage of population aged 14 years or under with correct vaccine status is high (over 91%) and has remained stable over time. Mortality in patients who have developed complications has increased, from 27.1% in 2012 to 34.0% in 2017. Most centres achieved functional improvements during the first 30 days of admission. Conclusions Among all indicators measured in primary care, hospital and long‐term care, only 14 analysed are nursing‐sensitive; no nursing‐sensitive indicators regarding mental health are measured. Implications for Nursing Management Research focused on development of nursing‐sensitive indicators offers an opportunity to measure and benchmark nurses’ quality of care and their contribution in achieving populations’ health improvement and health care system sustainability.

show abstract

Pflegeintensität und pflegesensitive Ergebnisindikatoren in deutschen Krankenhäusern

Winter¹,

Schreyögg²,

Blume³

2023

Krankenhaus-Report 2023

View full text Add to dashboard Cite

ZusammenfassungDer vorliegende Beitrag gibt einen Einblick in den aktuellen Stand der Forschung zum Zusammenhang zwischen der Pflegepersonalausstattung und Patientenergebnissen. Dabei sollen sowohl die internationale Forschung synthetisiert als auch empirische Evidenz aus deutschen Krankenhäusern geliefert werden. Letztere wurde im Innovationsfonds-Projekt „PPE: Pflegesensitive patient:innenbezogene Ergebnisindikatoren“ generiert. Die Pflegepersonalausstattung umfasst dabei zwei Aspekte: zum einen das Patienten-Pflegepersonal-Verhältnis, sprich wie viele Patientinnen und Patienten eine Pflegekraft durchschnittlich zu versorgen hat. Zum zweiten geht es um den Qualifikationsmix, also die Frage, wie das Verhältnis von Pflegekräften mit dreijähriger Ausbildung zu kürzer ausgebildeten Pflegekräften ist. Die untersuchten Patientenergebnisse umfassten Letalität, Wiederaufnahmen ins Krankenhaus, Druckgeschwüre, Lungenversagen, Pneumonie und Sepsis (auf Basis von Abrechnungsdaten der TK-Krankenkasse) sowie die von Patientinnen und Patienten erlebte Pflegequalität im Krankenhaus, wofür eine umfangreiche Befragung von TK-Versicherten durchgeführt wurde. Es wurden signifikante Zusammenhänge zwischen der Pflegepersonalausstattung und Patientenergebnissen festgestellt, wobei die Anzahl signifikanter Ergebnisse substanziell von der betrachteten Fachabteilung und dem Patienten-Outcome abhing. Unter den klinisch beobachtbaren Patientenergebnissen zeigte sich die stärkste empirische Evidenz für die Pflegesensitivität von Pneumonie und Lungenversagen, wohingegen die Evidenz für globalere Outcomes wie Letalität und Wiederaufnahmen schwächer war. Für alle drei untersuchten Dimensionen von der von Patientinnen und Patienten erlebten Pflegequalität zeigte sich ein signifikanter Zusammenhang sowohl mit der Pflegepersonalausstattung als auch mit dem Qualifikationsmix. Die Ergebnisse wurden zu verschiedenen Zeitpunkten mit Fachleuten aus der Praxis, unter anderem des Verbandes der Universitätsklinika Deutschlands (VUD), diskutiert.

show abstract

The relationship between nurse staffing levels and nursing-sensitive outcomes in hospitals: Assessing heterogeneity among unit and outcome types

Cited by 16 publications

References 54 publications

The impact of nurse staffing levels on nursing-sensitive patient outcomes: a multilevel regression approach

The impact of nurse staffing levels on nursing-sensitive patient outcomes: a multilevel regression approach

The experience of Catalonia measuring nurse‐sensitive indicators: Trends study 2012–2018

Pflegeintensität und pflegesensitive Ergebnisindikatoren in deutschen Krankenhäusern

Contact Info

Product

Resources

About