Economic Evaluation of the 80% Baccalaureate Nurse Workforce Recommendation

A Patient-level Analysis

Datos Bibliográficos

ID9101433
AutoresOlga Yakusheva (0000-0001-5501-1397, University of Michigan, autor de correspondencia), Richard C Lindrooth (0000-0001-9538-9749, University of Colorado Anschutz Medical Campus), Richard Lindrooth, Marianne Wei (0000-0003-4217-9822, Marquette University), Marianne Weiss
Año2014
Volumen52
Número10
Páginas864-869
Fecha de publicación2014-10-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000189
PMID25215646
OpenAlexW2144299273
IdiomaEN
Citas recibidas7
Referencias citadas22

BACKGROUND: Higher proportions of BSN-educated nurses were associated with improved outcomes in hospital-level studies. A recent Institute of Medicine report calls for increasing the proportion of BSN-educated nurses to 80% by 2020. Patient-level evidence of cost and quality implications of the 80% BSN threshold is needed for a business case to support these efforts. OBJECTIVES: To conduct the economic analysis of meeting the 80% BSN threshold on patient outcomes and costs, using linked patient-nurse data. RESEARCH DESIGN: Retrospective observational patient-level analysis of electronic data. Linear and logistic regression modeling with patient controls and diagnosis and unit fixed effects. SUBJECTS: A total of 8526 adult medical-surgical patients matched with 1477 direct care nurses from an Eastern US academic medical center, during June 1, 2011-December 31, 2011. MEASURES: Outcomes include hospital mortality, all-cause same-facility 30-day readmission, length-of-stay, and total hospitalization cost. BSN proportion is a continuous measure for the proportion of nurse assessment inputs into the patient's electronic medical record made by BSN-educated nurses; a dichotomous indicator for BSN proportion is 0.8-1.0. RESULTS: Continuous BSN proportion was associated with lower mortality (OR=0.891, P<0.01). Compared with patients with <80% BSN care, patients receiving ≥ 80% of care from BSN nurses had lower odds of readmission (OR=0.813, P=0.04) and 1.9% shorter length-of-stay (P=0.03). Economic simulations support a strong business case for increasing the proportion of BSN-educated nurses to 80%. CONCLUSIONS: A combined approach of increasing the hospital-level BSN proportion to 80% and assuring a high BSN dose through individual patient-level staffing assignments is needed to achieve projected quality and costs benefits

Family medicine · Logistic regression · MEDLINE · Observational study · Odds · Odds ratio · Patient care · Workforce · Emergency Medicine · Hospital Admissions and Outcomes · Internal Medicine · Medicine · Nursing · Nursing education and management · Nursing Roles and Practices