title: Nursing contribution to the achievement of prioritized objectives in primary health care: a cross-sectional study.
abstract: BACKGROUND
  Concern for the sustainability of health care systems has forced health authorities and insurance companies to develop performance measurement systems to promote the achievement of health objectives. These actions aim to stimulate quality improvement while controlling costs by making providers accountable for what they do as well as for the quality of the care they provide. However, the extent to which each professional contributes to the achievement of the health objectives is largely unknown. The aim of this study was to analyse the contribution of nurses to achieving the objectives for primary health care (PHC) services prioritized by the public insurer.
  
  
  METHODS
  A cross-sectional study was conducted using data from the PHC services of the public healthcare network in Catalonia, Spain, during the period 2006-09. Indicators linked to the prioritized health objectives were classified as nursing sensitive and non-nursing sensitive using criteria defined by international institutions. A multilevel linear regression model was applied to evaluate the temporal evolution of the two sets of indicators.
  
  
  RESULTS
  Specifically, 39.4% of the indicators linked to the health objectives were nursing sensitive. The evolution of the indicators showed an improvement in the achievement of most of the prioritized objectives. Although this improvement was greater for nursing-sensitive indicator outcomes, the difference did not reach statistical significance (P = 0.09).
  
  
  CONCLUSIONS
  Nursing has a relevant role in the achievement of a significant number of health objectives in PHC services. This contribution should be recognized as it has important consequences in terms of service payment and public health.
authors.affiliation: 1 Directorate for Health Planning and Research, Ministry of Health, Government of Catalonia, Barcelona 2 Department of Fundamental Nursing and Medical-Surgery, University of Barcelona, School of Nursing, Barcelona, Spain planascarme@gmail.com.
authors.forename: Carme
authors.initials: C
authors.lastname: Planas-Campmany
authors.affiliation: 3 ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quintó
authors.affiliation: 4 Department of Public Health, Mental Health and Perinatal Nursing, University of Barcelona, School of Nursing, Barcelona, Spain.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Icart-Isern
authors.affiliation: 5 Catalan Health Service, Government of Catalonia, Barcelona, Spain.
authors.forename: Elena M
authors.initials: EM
authors.lastname: Calvo
authors.affiliation: 3 ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Ordi
mesh_terms: D003430:Cross-Sectional Studies; D006292:Health Priorities / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D024802:Nurse's Role; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D013030:Spain; D013222:State Medicine / Q000191:economics / Q000458:organization & administration*