title: Nurse Staffing and 30-day Readmission of Chronic Obstructive Pulmonary Disease Patients: A 10-year Retrospective Study of Patient Hospitalization.
abstract: OBJECTIVE
  Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity in many countries, and it has high rate of hospital readmissions due to recurrent exacerbations of the disease. Many previous studies have suggested further examination of the factors that contribute to hospital readmissions of COPD patients. However, evidence on the effects of nurse staffing by registered nurses (RNs) on the readmission of COPD patients is lacking in Korea. The aim of our study was to evaluate the effects of nurse staffing on hospital readmissions of COPD patients.
  
  
  METHODS
  We used National Health Insurance claim data from 2002 to 2012. A total of 1,070 hospitals and 339,379 hospitalization cases were included in the analysis. We divided the number of RNs per 100 beds and the proportion of RNs on staff to one of three groups (Q1: low; Q2: moderate; Q3: high). A generalized estimating equation model was used to evaluate the associations between readmission and nurse staffing.
  
  
  RESULTS
  A higher number of RNs was associated with lower readmission rates of 8.9% (Q2) and 7.9% (Q3) respectively. A similar effect was observed as the proportion of RNs among the total nursing staff gradually increased, resulting in lower readmission rates of 7.7% (Q2) and 8.3% (Q3).
  
  
  CONCLUSIONS
  Our results suggest notable positive effects of nurse staffing by RNs on patient outcomes. In addition, the magnitude of impact differed between different sizes of hospitals. Thus, human resource planning to solve staffing shortages should carefully consider the qualitative aspects of the nursing staff composition.
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea; Institute of Health Services Research, Yonsei University, Seoul, South Korea.
authors.forename: Seung Ju
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Institute of Health Services Research, Yonsei University, Seoul, South Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea; Institute of Health Services Research, Yonsei University, Seoul, South Korea.
authors.forename: Kyu-Tae
authors.initials: KT
authors.lastname: Han
authors.affiliation: Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, South Korea.
authors.forename: Sun Jung
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Institute of Health Services Research, Yonsei University, Seoul, South Korea; Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, South Korea. Electronic address: thkim@yuhs.ac.
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
mesh_terms: D000368:Aged; D005260:Female; D006276:Health Facility Size / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009726:Nurses / Q000600:supply & distribution*; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010561:Personnel Staffing and Scheduling; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing*; D011787:Quality of Health Care; D012008:Recurrence; D056910:Republic of Korea; D012189:Retrospective Studies
keywords: health resources; nursing staff; patient readmission; quality of health care