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Policy, Politics, & Nursing Practice, Vol. 9, No. 2, 88-93 (2008)
DOI: 10.1177/1527154408320420

The Business Case for Nursing in Long-Term Care

Susan D. Horn, PhD

Institute for Clinical Outcomes Research, shorn{at}isisicor.com

Lower nurse staffing in hospitals has been associated with adverse patient outcomes; results in nursing homes (NHs) are less clear. We examined the association between nurses' direct care time and outcomes in long-stay NH residents and potential cost savings from decreased adverse outcomes versus additional wages for adequate nurse staffing. Data were from the National Pressure Ulcer Long-Term Care Study of 1,376 at-risk residents from 82 NHs. Primary data came from medical records. Hospital, pressure ulcer (PrU) treatment, and urinary tract infection (UTI) costs were from national statistics or cost-identification studies. Time horizon was 1 year. More registered nurse (RN) direct care time/resident/day was associated with fewer PrUs, hospitalizations, and UTIs. Annual net societal benefit was $3,191/resident/year in high-risk NH units with 30-40 min of RN time/resident/day versus units with <10 min. Thus, after controlling for important variables, more RN time/day was strongly associated with better outcomes and lower societal cost.

Key Words: nursing home staffing • business case for nursing staffing • nurse staffing associated with resident outcomes

References

  • Agency for Healthcare Research and Quality. ( 2002). Healthcare cost and utilization project (HCUP), 1988-2000: A federal-state-industry partnership in health data. Retrieved from http://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2000.jsp
  • Aiken, L.H., Clarke, S.P., Cheung, D.M., Sloane, D.M., & Silber, J.H. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290, 1617-1623.[Abstract/Free Full Text]
  • American Medical Directors Association. (1996 ). Pressure ulcers. Clinical practice guideline. Columbia, MD: Author.
  • Brandeis, G.H., Ooi, W.L., Hossain, M., Morris, J.N., and Lipsitz, L.A. (1994). A longitudinal study of risk factors associated with the formation of pressure ulcers in nursing homes. Journal of the American Geriatrics Society, 42(4): 388-393.[Medline] [Order article via Infotrieve]
  • Buchanan, J.L., Arnold, S.B., Bell, R.M., Gerard, J., Kane, R.L., & Witsberger, C.J. (1990). Assessing cost effects of nursing-home-based geriatric nurse practitioners. Health Care Financing Review, 11(3), 67-78.[Medline] [Order article via Infotrieve]
  • Casalino, L.P. (2003). Markets and medicine: Barriers to creating a "business case for quality." Perspectives in Biology and Medicine, 46, 38-54.[Medline] [Order article via Infotrieve]
  • Cavanagh, S.J., & Bamford, M. (1997). Substitution in nursing practice: Clinical, management and research implications. Journal of Nursing Management, 5(6), 333-339.[CrossRef][Medline] [Order article via Infotrieve]
  • Chappell, H., & Dickey, C. (1993). Decreased rehospitalization costs through intermittent nursing visits to nursing home patients. Journal of Nursing Administration, 23(3), 49-52.[Medline] [Order article via Infotrieve]
  • Chen, Q., Kane, R.L., & Finch, M.D. (2000). The cost effectiveness of post-acute care for elderly Medicare beneficiaries. Inquiry, 37(4), 359-375.[Medline] [Order article via Infotrieve]
  • Center for Medicare & Medicaid Services. ( 2005). Medicare "Pay-for-Performance (P4P)" Initiatives. Retrieved from http://www.cms.hhs.gov/apps/media/press/release.asp?counter=1343
  • Dorr, D.A., Horn, S.D., & Smout, R.J. (2005). Cost analysis of nursing home registered nurse staffing times. Journal of the American Geriatrics Society, 53, 840-845.[CrossRef][Medline] [Order article via Infotrieve]
  • Grabowski, D.C., Angelelli, J.J., & Mor, V. (2004). Medicaid payment and risk-adjusted nursing home quality measures. Health Affairs, 23, 243-252.[Abstract/Free Full Text]
  • Hall, L.M. (1997). Staff mix models: Complementary or substitution roles for nurses. Nursing Administration Quarterly, 2, 31-9.
  • Heffler, S., Smith, S., Keehan, S., Borger, C., Clemens, M.K., & Truffer, C. (2005). Trends: U.S. health spending projections for 2004-2014. Health Affairs, 24(1), w5-74-w5-85.
  • Horn, S. D. (Ed). (1997). Clinical practice improvement methodology: Implementation and evaluation. New York: Faulkner & Gray.
  • Horn, S.D., Bender, S.A., Bergstrom, N., Cook, A.S., Ferguson, M.L., Rimmasch, H.L., et al. (2002). Description of the national pressure ulcer long-term care study (NPULS). Journal of the American Geriatrics Society, 50, 1816-1825.[CrossRef][Medline] [Order article via Infotrieve]
  • Horn, S.D., Bender, S.A., Ferguson, M.L., Smout, R.J., Bergstrom, N., Taler, G., et al. (2004). The national pressure ulcer long-term care study: Pressure ulcer development in long-term care residents. Journal of the American Geriatrics Society. 52(3), 359-367.[CrossRef][Medline] [Order article via Infotrieve]
  • Horn, S.D., Buerhaus, P., Bergstrom, N., & Smout, R.J. (2005). Association between registered nurse staffing time and outcomes of long-stay nursing home residents. American Journal of Nursing, 105(11), 58-71.[Medline] [Order article via Infotrieve]
  • Johnson-Pawlson, J., & Infeld, D.L. (1996). Nurse staffing and quality of care in nursing facilities. Journal of Gerontological Nursing, 22(8), 36-45.[Medline] [Order article via Infotrieve]
  • Jones, A. (2002). The national nursing home survey, 1999 Summary. Centers for Disease Control and Prevention, Division of Health Care Statistics. Available at http://www.cdc.gov/nchs/data/series/sr_13/sr13_152.pdf
  • Kovner, C., & Gergen, P.J. (1998). Nurse staffing levels and adverse events following surgery in U.S. hospitals. Journal of Nursing Scholarship, 30(4), 315-321.[CrossRef]
  • Kovner, C., Mezey, M., & Harrington, C. (2000). Research priorities for staffing, case mix, and quality of care in U.S. nursing homes. Journal of Nursing Scholarship, 32(1), 77-80.[CrossRef][Medline] [Order article via Infotrieve]
  • Kovner, C., Mezey, M., & Harrington, C. (2002). Who cares for older adults? Workforce implication of an aging society. Health Affairs, 21(5), 78-89.[Abstract/Free Full Text]
  • Lichtig, L.K., Knauf, R., & Milholland, D.K. (1999). Some impacts of nursing on acute care hospital outcomes. Journal of Nursing Administration, 29(2), 25-33.[Medline] [Order article via Infotrieve]
  • Li-McLeod, J., Cislo, P., & Gomolin, I. (2000). Cost analysis of ciprofloxacin oral suspension vs. trimethoprim/sulfamethoxazole oral suspension for treatment of acute urinary tract infections in elderly women. American Society of Consultant Pharmacists Annual Meeting; Boston, MA.
  • Lyder, C.H., Preston, J., Grady, J.N., Scinto, J., Allman, R., Bergstrom, N., et al. (2001). Quality of care for hospitalized medicare patients at risk for pressure ulcers. Archives of Internal Medicine, 161, 1549-1554.[Abstract/Free Full Text]
  • Miller, H., & Delozier, J. (1994). Cost implications of the pressure ulcer treatment guideline. A report to the U. S. Agency for Healthcare Policy and Research, Panel for the Treatment of Pressure Ulcers. Columbia, MD: Center for Health Policy Studies.
  • Morris, J.M., Moore, T., & Jones, R. (2003). Validation of long-term and post-acute care quality indicators. Retrieved from http://www.interrai.org/applications/qireport2.pdf
  • Munroe, D. (1990). The influence of registered nurse staffing on the quality of nursing home care. Research in Nursing and Health, 13(4), 263-70[CrossRef]
  • National Bureau of Economic Research. (2003 ). Current population survey merged outgoing rotation groups, 1994-2002. [CD ROM]. Washington, DC: U.S. Bureau of the Census.
  • Needleman, J. (2008, in press). Is what's good for the patient good for the hospital? Aligning incentives and the business case for nursing. Policy, Politics & Nursing Practice, 9(2).
  • Needleman, J., Buerhaus, P.I., Stewart, M., Zelevinsky, K., & Mattke, S. (2006). Nurse staffing in hospitals: Is there a business case for quality? Health Affairs, 25(2), 571.[Free Full Text]
  • Needleman, J.P., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse staffing and quality of care in hospitals in the United States. New England Journal of Medicine, 346(22), 171-175.
  • Page, A. (Ed.). (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC. The National Academies Press.
  • Panel for the Prediction of Pressure Ulcers in Adults. (1992). Pressure ulcers in adults: Prediction and prevention. Clinical Practice Guideline, Number 3. AHCPR Publication No. 92-0047. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services.
  • Rice, T. (1997). Can markets give us the health system we want? Journal of Health Politics, Policy and Law, 22(2), 383-426.
  • Spector, W.D. (1994). Correlates of pressure sores in nursing homes: Evidence from the National Medical Expenditure Survey. Journal of Investigational Dermatology, 102(6), 42S-45S.[CrossRef]
  • Unruh, L. (2003). Licensed nurse staffing and adverse events in hospitals. Medical Care, 41(1), 142-52.[CrossRef][Medline] [Order article via Infotrieve]
  • Weisbrod, B. (1991). The health care quadrilemma: An essay on technological change, insurance, quality or care, and cost containment. Journal of Economic Literature, 29, 523-552.
  • Wunderich, G. S., Sloan, F., & Davis, C. D., (Eds.). (1996). Nurse staffing in hospitals and nursing homes: Is it adequate? Washington, DC: National Academy Press.
  • Wunderlich, G. S., & Kohler, P. O. (Eds.). (2001). Improving the quality of long-term care. Washington, DC: National Academy Press.
  • Xakellis, G.C., & Frantz, R. (1996). The cost of healing pressure ulcers across multiple health care settings. Advances in Wound Care, 9(6), 18-22.[Medline] [Order article via Infotrieve]
  • Zimmerman, D.R., Karon, S.L., Arling, G., Clark, B., Collins, R., Ross, R., et al. (1995). Development and Testing of Nursing Home Quality Indicators. Health Care Financing Review. 16(4), 107-127.[Medline] [Order article via Infotrieve]

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