title: Cost-effectiveness of recommended nurse staffing levels for short-stay skilled nursing facility patients.
abstract: BACKGROUND
  Among patients in skilled nursing facilities for post-acute care, increased registered nurse, total licensed staff, and nurse assistant staffing is associated with a decreased rate of hospital transfer for selected diagnoses. However, the cost-effectiveness of increasing staffing to recommended levels is unknown.
  
  
  METHODS
  Using a Markov cohort simulation, we estimated the incremental cost-effectiveness of recommended staffing versus median staffing in patients admitted to skilled nursing facilities for post-acute care. The outcomes of interest were life expectancy, quality-adjusted life expectancy, and incremental cost-effectiveness.
  
  
  RESULTS
  The incremental cost-effectiveness of recommended staffing versus median staffing was $321,000 per discounted quality-adjusted life year gained. One-way sensitivity analyses demonstrated that the cost-effectiveness ratio was most sensitive to the likelihood of acute hospitalization from the nursing home. The cost-effectiveness ratio was also sensitive to the rapidity with which patients in the recommended staffing scenario recovered health-related quality of life as compared to the median staffing scenario. The cost-effectiveness ratio was not sensitive to other parameters.
  
  
  CONCLUSIONS
  Adopting recommended nurse staffing for short-stay nursing home patients cannot be justified on the basis of decreased hospital transfer rates alone, except in facilities with high baseline hospital transfer rates. Increasing nurse staffing would be justified if health-related quality of life of nursing home patients improved substantially from greater nurse and nurse assistant presence.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Veterans Affairs Greater Los Angeles Health Care System and University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90024, USA. dganz@mednet.ucla.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Ganz
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Simmons
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
mesh_terms: D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D006278:Medicare; D009741:Nursing Staff, Hospital / Q000191:economics / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling / Q000191:economics / Q000592:standards*; D011787:Quality of Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D017751:Safety Management; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D014481:United States; D000078329:Workforce