title: Matching Registered Nurse services with changing care demands (MatchRN): study protocol of a natural experiment multi-centre study.
abstract: OBJECTIVE
  The aim of this study was to examine how patient safety indicators and processes and structures of nursing care have changed since the 2012 introduction of Swiss Diagnosis-Related Groups.
  
  
  BACKGROUND
  Diagnosis-Related Groups have been implemented worldwide; yet, research findings regarding their impact on efficiency and quality of care remain inconsistent. The Matching Registered Nurse Services with Changing Care Demands study will assess how structures, processes and patient and nurse outcomes have changed in Swiss acute care hospitals since the introduction of Swiss Diagnosis-Related Groups.
  
  
  METHODS
  A multi-centre observational study nested in a natural experiment.
  
  
  METHODS
  To explore the effect of implementing Diagnosis-Related Groups in Switzerland we will compare nurse and patient survey data from 2010 with data from 2015 and eventually from 2017. Initially, we will match survey data from 78 medical and surgical units of 21 hospitals that participated in 2010 and 2015. Study variables related to structures and processes of nursing care (e.g. staffing/skill mix level, nurse work environment, rationing of nursing care), as well as patient and nurse outcomes, were assessed with well-established instruments. In 2017, a follow-up survey will be conducted to explore long-term implications. Furthermore, 6 years' medical and surgical patient discharge data (collected 2010-2015) will be analysed to assess changes in the severity of patient illness, length of stay and selected patient safety indicators.
  
  
  CONCLUSIONS
  This study's results will provide evidence regarding Diagnosis-Related Groups influences on Swiss nursing services and patient safety outcomes.
authors.affiliation: Nursing Science (INS), University of Basel, Switzerland.
authors.forename: Stefanie
authors.identifier: http://orcid.org/0000-0002-2747-3866
authors.initials: S
authors.lastname: Bachnick
authors.affiliation: Claudiana College of Health-Care Professions, Bolzano, Italy.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Ausserhofer
authors.affiliation: EHESP - School of Public Health, University Sorbonne Paris City, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Januel
authors.affiliation: Nursing Research Unit, Inselspital Bern University Hospital, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Schubert
authors.affiliation: Nursing Science (INS), University of Basel, Switzerland.|University Hospital Basel, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Schwendimann
authors.affiliation: Nursing Science (INS), University of Basel, Switzerland.|Department of Primary Care and Public Health, Academic Center for Nursing and Midwifery, KU Leuven, Belgium.
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
authors.affiliation: Nursing Science (INS), University of Basel, Switzerland.|Nursing Research Unit, Inselspital Bern University Hospital, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Simon
mesh_terms: D006801:Humans; D009732:Nursing Care; D013557:Switzerland
keywords: diagnosis-related groups; hospitals; natural experiment design; nursing care; quality of health care; survey; work environment