The primary purpose of this study is to measure patient-level direct nursing care time, and its associated costs, and link these to a widely-used measure of short term nursing acuity, the Nursing Outcomes Classification (NOC). The proposed study is being conducted as part of a national effort to leverage emerging data science and big data capability to measure nursing care value across many different settings and populations. The proposed study extends this work into a pediatric inpatient population and adds a new method to link the cost of nursing care with outcomes using the NOC data.
The specific aims of the study are to: 1. Measure nursing direct care time and costs by patient, day of stay, and APR-DRG; 2. Validate the relationship between nursing direct care time/cost by acuity level using NOC score and; 3. Estimate the relationship between nurse-patient allocation (assignment) and patient acuity using the NOC score controlling for patient, nurse and unit characteristics. The proposed research is a retrospective observational study using data a nationally recognized West Coast children's hospital using sequential admissions of all patients during the calendar year of 2016. Total admissions are anticipated to be approximately 20,000 and inpatient days 100,000. The study will extract key data from a nursing acuity and staffing/scheduling system as well as link data from the hospital human resources system. Key variables include: patient characteristic and demographics; nurse characteristics include experience level and academic preparation; discharge data including diagnosis (APR-DRG); NOC data which include 16 items such as respiratory status, pain and discomfort, etc. collected every 4 hours; direct care hours collected by shift and linked to nurse wage; and unit information such as unit churn (admissions, discharge, and transfers). Descriptive statistics will provide information related to the overall objectives. Sub analyses will be conducted to identify the key drivers of nursing cost and intensity using subscales of the NOC instrument. Generalized linear models (GLM) will be used to estimate the relationship between total nursing direct costs and direct care time on patient, nurse, and unit demographic data. Lastly, cost analysis will be conducted by patient and summarized by APR-DRG and by outcomes of care. The proposed study will provide a foundation for both methods to allocate nursing direct care time and costs to individual patients and prepare for causal analysis of nursing value at the individual patient unit of analysis. We anticipate conducting a follow up study at multiple institutions using the methods in this proposed study that will allow identification and benchmarking of nursing care time and costs by diagnosis and day of stay across different care settings in different areas of the country.

Public Health Relevance

This project addresses a key public health priority to improve health care affordability, efficiency and cost transparency. The proposed study uses a novel method to identify and analyze acute care nursing direct care time and costs for each patient in a pediatric setting. The findings from this study will help to identify methods to optimize nursing care resources to better meet patient needs.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Small Research Grants (R03)
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Healthcare Effectiveness and Outcomes Research (HEOR)
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Freeman, William
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University of Colorado Denver
Schools of Nursing
United States
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