title: Lower mortality in magnet hospitals.
abstract: BACKGROUND
  Although there is evidence that hospitals recognized for nursing excellence--Magnet hospitals--are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why.
  
  
  OBJECTIVE
  To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations. METHOD AND STUDY DESIGN: Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences.
  
  
  RESULTS
  Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76-0.98; P=0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77-1.01; P=0.07) while controlling for nursing factors as well as hospital and patient differences.
  
  
  CONCLUSIONS
  The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes.
authors.affiliation: Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA. mchughm@nursing.upenn.edu
authors.forename: Matthew D
authors.initials: MD
authors.lastname: McHugh
authors.forename: Lesly A
authors.initials: LA
authors.lastname: Kelly
authors.forename: Herbert L
authors.initials: HL
authors.lastname: Smith
authors.forename: Evan S
authors.initials: ES
authors.lastname: Wu
authors.forename: Jill M
authors.initials: JM
authors.lastname: Vanak
authors.forename: Linda H
authors.initials: LH
authors.lastname: Aiken
mesh_terms: D002983:Clinical Competence; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D009741:Nursing Staff, Hospital / Q000193:education / Q000592:standards*; D015279:Organizational Culture; D011787:Quality of Health Care; D014481:United States / Q000453:epidemiology