miércoles, 3 de febrero de 2016

Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk. - PubMed - NCBI

Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk. - PubMed - NCBI

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AHRQ Study: Better Work Environment for Nurses Does Not Necessarily Mean Higher Value

Improving the work environment for nurses in hospitals may not lead to improvement in value, according to a recently published study in JAMA Surgery. The study addresses work environments’ effect on value (i.e., cost vs. quality), because while it is generally thought that hospitals with better nurse work environments provide higher quality of care, less is known about the environments’ effect on value. In this study, partially funded by AHRQ, researchers analyzed Medicare records in Illinois, New York and Texas. They compared outcomes and costs of nearly 26,000 patients at 35 hospitals recognized nationally as having good nurse work environments and high nurse-to-bed ratios against nearly 63,000 patients at 298 control hospitals from 2004 to 2006. They found that the 30-day mortality rate in the hospitals with good work environments was 4.8 percent versus 5.8 percent in the control hospitals, while the cost per patient was similar. Read the abstract.

 2016 Jan 20. doi: 10.1001/jamasurg.2015.4908. [Epub ahead of print]

Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk.



The literature suggests that hospitals with better nursing work environments provide better quality of care. Less is known aboutvalue (cost vs quality).


To test whether hospitals with better nursing work environments displayed better value than those with worse nursing environmentsand to determine patient risk groups associated with the greatest value.


A retrospective matched-cohort design, comparing the outcomes and cost of patients at focal hospitals recognized nationally as having good nurse working environments and nurse-to-bed ratios of 1 or greater with patients at control group hospitals without such recognition and with nurse-to-bed ratios less than 1. This study included 25 752 elderly Medicare general surgery patients treated at focal hospitals and 62 882 patients treated at control hospitals during 2004-2006 in Illinois, New York, and Texas. The study was conducted between January 1, 2004, and November 30, 2006; this analysis was conducted from April to August 2015.


Focal vs control hospitals (better vs worse nursing environment).


Thirty-day mortality and costs reflecting resource utilization.


This study was conducted at 35 focal hospitals (mean nurse-to-bed ratio, 1.51) and 293 control hospitals (mean nurse-to-bed ratio, 0.69). Focal hospitals were larger and more teaching and technology intensive than control hospitals. Thirty-day mortality in focal hospitals was 4.8% vs 5.8% in control hospitals (P < .001), while the cost per patient was similar: the focal-control was -$163 (95% CI = -$542 to $215; P = .40), suggestingbetter value in the focal group. For the focal vs control hospitals, the greatest mortality benefit (17.3% vs 19.9%; P < .001) occurred in patients in the highest risk quintile, with a nonsignificant cost difference of $941 per patient ($53 701 vs $52 760; P = .25). The greatest difference in value between focal and control hospitals appeared in patients in the second-highest risk quintile, with mortality of 4.2% vs 5.8% (P < .001), with a nonsignificant cost difference of -$862 ($33 513 vs $34 375; P = .12).


Hospitals with better nursing environments and above-average staffing levels were associated with better value(lower mortality with similar costs) compared with hospitals without nursing environment recognition and with below-average staffing, especially for higher-risk patients. These results do not suggest that improving any specific hospital's nursing environment will necessarily improve its value, but they do show that patients undergoing general surgery at hospitals with better nursing environments generally receive care of higher value.

[PubMed - as supplied by publisher]

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