Examining the link between nursing inputs and patient care quality

The recent availability of additional measurement tools and improvements in some pre-existing performance indicators for California hospitals may allow us to understand the link between nursing inputs and patient care quality better than has been possible previously. This may stimulate public reporting (PR) and pay-for-performance (PFP) targeting nursing measures. The purpose of this study is to explore the relationships between nursing inputs and: (1) nursing sensitive JCAHO process measures; (2) patient satisfaction using the unique, but largely generalizable California HCAHPS +9; (3) complications identified from administrative data when these are measured using the condition present at admission (CPAA) variable (including FTR); (4) the prevalence of hospital-acquired pressure ulcers (HAPU); and (5) overall nursing performance as measured by composite indicators comprising patient perceptions of care, process measures, and other selected outcomes of care such as complication rates. This descriptive study will use data from over 160 hospitals in California, using structural measures of nursing inputs as independent variables, and process and outcome measures as dependent variables. Data for the complications and FTR measures will include new condition present at admission data. The data for all questions will be analyzed using hierarchical modeling and factor analysis will be used for composite measure development. This work will inform all major stakeholders within the healthcare community (consumers, purchasers, health plans, hospitals and policy-makers) and increase focus on measures of nursing care quality and their usefulness in public reporting and PFP initiatives. In addition to the usual academic channels, results of the study will be disseminated through an established public reporting format in California run by the research team, and hence will be implemented immediately.

Grant Details

Amount Awarded $300,000.00

Awarded on: 7/31/2007

Time frame: 9/1/2007 - 8/31/2009

Grant Number: 62600


University of California, San Francisco

513 Parnassus Avenue
San Francisco, 94143-2205


Arlyss Anderson Rothman
Project Director