The primary purpose of this project is to examine the relationships among nurse staffing (RNs/1000 case mix adjusted patient days, RNs as percent of total hospital workforce, RN FTEs per average adjusted daily census), hospital financial performance (cash flow/bed, net patient revenue/discharge, expenses/discharge), and quality of care (risk adjusted mortality, length of stay, and complications). The research questions are: After controlling for relevant population, market, and hospital characteristics, 1) What is the nature of the relationship between change in nurse staffing and change in quality of care? 2) What is the nature of the relationship between change in hospital financial performance and change in nurse staffing? 3) What is the nature of the relationship between change in hospital financial performance and change in nurse staffing? 4) Are these relationships dependent upon the extent of managed care penetration in the community? 5) Are these relationships dependent upon ownership status of the hospital (i.e., profit vs. not-for-profit)? The project is a pooled, cross-sectional, repeated measures design, utilizing 6 years of data (1990 - 1995) obtained from the American Hospital Association Annual Surveys, the HCFA Provider of Services Files, HCFA Minimum Cost and Capital Data Files, the Area Resource Files, and the HCUP National Inpatient Sample data files. The sample is comprise of 422 acute care hospitals participating in the HCUP longitudinal cohort. Data will be analyzed with econometric models developed for dynamic panel data with lagged instrumental variables using the generalized method of moments. The project is responsive to AHCPR's call for research that will support improvements in outcomes, and on organizational and financial aspects of health care. The project has significant policy relevance in terms of better understanding the impact of managed care on cost-quality tradeoffs in the high-intensity, high- cost acute care hospital.
