title: Economic evaluation of the 80% baccalaureate nurse workforce recommendation: a patient-level analysis.
abstract: 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.
  
  
  OBJECTIVE
  To conduct the economic analysis of meeting the 80% BSN threshold on patient outcomes and costs, using linked patient-nurse data.
  
  
  METHODS
  Retrospective observational patient-level analysis of electronic data. Linear and logistic regression modeling with patient controls and diagnosis and unit fixed effects.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: *Division of Systems Leadership and Effectiveness Science, School of Nursing, Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI †Department of Health Systems, Management and Policy, School of Public Health, University of Colorado, Aurora, CO ‡College of Nursing, Marquette University, Milwaukee, WI.
authors.forename: Olga
authors.initials: O
authors.lastname: Yakusheva
authors.forename: Richard
authors.initials: R
authors.lastname: Lindrooth
authors.forename: Marianne
authors.initials: M
authors.lastname: Weiss
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004508:Education, Nursing, Baccalaureate / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States