The business case for nursing in long-term care.
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.
Horn
Susan D
SD
Institute for Clinical Outcomes Research, University of Utah School of Medicine, Salt Lake City, UT, USA. shorn@isisicor.com
D000369:Aged, 80 and over; D003132:Commerce; D017046:Cost Savings; D017281:Cost of Illness; D004180:Direct Service Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015994:Incidence; D008134:Long-Term Care / Q000191:economics*; D015401:Nursing Administration Research; D009735:Nursing Homes / Q000191:economics*; D009740:Nursing Staff / Q000191:economics* / Q000600:supply & distribution; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling / Q000191:economics*; D003668:Pressure Ulcer / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D019984:Quality Indicators, Health Care / Q000191:economics; D011787:Quality of Health Care / Q000191:economics*; D012189:Retrospective Studies; D012456:Salaries and Fringe Benefits / Q000191:economics; D013996:Time and Motion Studies; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D016526:Workload / Q000191:economics