Groundbreaking Study Provides Distinctive Analysis of Work of Health Professionals and Outcomes

ANN ARBOR, MI  – The value of nursing practice to patient outcomes has been investigated to date using data aggregated at the patient care unit or hospital level. Based on individual nurse level data linked to patient specific outcomes, Olga Yakusheva, PhD, and her team have demonstrated differences of individual nurse performance in quality of care. This groundbreaking research, released in a the new issue of Health Services Research featuring the Best of the 2014 AcademyHealth Annual Research Meeting, lays an empirical foundation for recognizing individual nurses as each being a unique and integral component of care delivery. Achieving high-quality patient care and reducing costs will require that high-performing nurses are identified, recognized, and rewarded.

 

“Nurse Value-Added and Patient Outcomes in Acute Care” provides an important new alternative to traditional hospital- and unit-level assessments of the nurse contributions to patient outcomes. Rather than treating nursing as a commodity, in which “a nurse is a nurse is a nurse,” Dr. Yakusheva says her approach opens the door to more meaningful data analysis.

 

“Nurses—like all health professionals—differ in their value-added to patient outcomes,” says Dr. Yakusheva, based on the study’s findings. She and her co-authors conclude: “The ability to measure individual nurse relative value-added opens the possibility for development of performance metrics, performance-based rankings, and merit-based salary schemes to improve patient outcomes and reduce costs.”

 

Using electronic data on 1,203 staff nurses matched with 7,318 adult medical-surgical patients discharged between July 2011 to December 2011 from an urban Magnet-designated, 854-bed teaching hospital, the study employed retrospective observational longitudinal analysis using a covariate-adjustment value-added model with nurse fixed effects. The aims of the study were to (1) estimate the relative nurse effectiveness, or individual nurse value-added (NVA), to patients’ clinical condition change during hospitalization; (2) examine nurse characteristics contributing to NVA; and (3) estimate the contribution of value-added nursing care to patient outcomes.

 

Principal findings were that nurse effects were jointly significant and explained 7.9 percent of variance in patient clinical condition change during hospitalization. NVA was positively associated with having a baccalaureate degree or higher (0.55, p = .04) and expertise level (0.66, p = .03). NVA contributed to patient outcomes of shorter length of stay and lower costs.