The impact of nurse staffing levels on nursing-sensitive patient outcomes: a multilevel regression approach

Karina Dietermann (), Vera Winter (), Udo Schneider () and Jonas Schreyögg ()
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Karina Dietermann: University of Hamburg
Vera Winter: University of Wuppertal
Udo Schneider: Health Care Management at Techniker Krankenkasse
Jonas Schreyögg: University of Hamburg

The European Journal of Health Economics, 2021, vol. 22, issue 5, No 12, 833-846

Abstract: Abstract The goal of this study is to provide empirical evidence of the impact of nurse staffing levels on seven nursing-sensitive patient outcomes (NSPOs) at the hospital unit level. Combining a very large set of claims data from a German health insurer with mandatory quality reports published by every hospital in Germany, our data set comprises approximately 3.2 million hospital stays in more than 900 hospitals over a period of 5 years. Accounting for the grouping structure of our data (i.e., patients grouped in unit types), we estimate cross-sectional, two-level generalized linear mixed models (GLMMs) with inpatient cases at level 1 and units types (e.g., internal medicine, geriatrics) at level 2. Our regressions yield 32 significant results in the expected direction. We find that differentiating between unit types using a multilevel regression approach and including postdischarge NSPOs adds important insights to our understanding of the relationship between nurse staffing levels and NSPOs. Extending our main model by categorizing inpatient cases according to their clinical complexity, we are able to rule out hidden effects beyond the level of unit types.

Keywords: Nurse staffing; Nursing-sensitive patient outcomes; Quality of care; Acute care; Multilevel models; J11 (search for similar items in EconPapers)
Date: 2021
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DOI: 10.1007/s10198-021-01292-2

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