1. Agency for Healthcare Research and Quality,Grant # R01 HS13094 Hospital Payment, Nurse Staffing, and the Outcomes of Patient Care Mei Zhao, Ph.D. University of North Florida Gloria J. Bazzoli, Ph.D. Virginia Commonwealth University

2. Rationale for the Study US hospital payment has been declining during the last several years Hospitals have been cutting staffing due to financial pressures Studies found that higher nurse staffing ratio is related to better patient outcomes, but most of these studies are cross-sectional Few studies ever examined the relationship among hospital payment, staffing decisions, and patient outcomes

3. Research Questions What is the effect of hospital payment on the quality of care and patient safety? What is the effect of hospital nurse staffing on the quality of care and patient safety?

4. Method Design A panel study design is applied to data from 1995-2000 Sampling Nonfederal short term general hosps from 11 states (AZ, CA, CO, FL, IA, MD, MA, NJ, NY,WA, and WI), about 1,100 per year Data Sources AHA, MCR, ARF, HCUP (SID) 1995-2000

5. Key Variables Payment Net patient revenue per adjusted patient day Staffing Indicators RNs per adjusted patient day LPNs per adjusted patient day Patient Outcomes IQIs (4): AMI, CHF, Stroke, and Pneumonia PSIs (4): Decubitus ulcer, infections due to medical care, post-op pulmonary embolism, and sepsis

6. Analytic Strategies Panel Analysis Fixed-effects Models

10. Conclusions Hospitals experiencing a decline in payment may compromise the care they provide to patients, but the impact is limited Hospital quality of patient care is only weakly related to changes in hospital nurse staffing Patient outcomes are influenced by the volume of care a hospital provides and its experience in treating severely ill patients

11. Significance to Policy and Future Research Health policy efforts focused on improving hospital quality should consider regionalization of certain types of care more so than implementing minimum staffing levels or enhancing hospital reimbursement Even if the relationship between patient outcomes and changes in staffing levels is minimal, it is important to investigate how staffing reductions may affect employee morale and productivity Many other patient outcome measures were not included