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Better Value Care at Hospitals With Best Nursing Environments

Thirty-day mortality lower in focal versus control hospitals, with similar cost per patient

nurse

MONDAY, Jan. 25, 2016 (HealthDay News) -- Hospitals with better nursing environments provide better value care, according to a study published online Jan. 20 in JAMA Surgery.

Jeffrey H. Silber, M.D., Ph.D., from the University of Pennsylvania in Philadelphia, and colleagues compared the outcomes and cost of patients at focal hospitals recognized nationally as having good nursing work environments and hospitals without such recognition. Data were included for 25,752 elderly Medicare general surgery patients treated at 35 focal hospitals (mean nurse-to-bed ratio, 1.51) and 62,882 patients treated at 293 control hospitals (mean nurse-to-bed ratio, 0.69).

The researchers found that in focal versus control hospitals, 30-day mortality was 4.8 versus 5.8 percent (P < 0.001), with similar cost per patient (focal − control, −$163; P = 0.40), indicating better value in the focal group. The greatest mortality benefit for the focal versus control hospitals was seen for patients in the highest risk quintile (17.3 versus 19.9 percent; P < 0.001), with a nonsignificant cost difference of $941 per patient (P = 0.25). Patients in the second-highest risk quintile had the greatest difference in value between focal and control hospitals, with mortality of 4.2 versus 5.8 percent (P < 0.001) and a nonsignificant cost difference of −$862 (P = 0.12).

"[These results] show that patients undergoing general surgery at hospitals with better nursing environments generally receive care of higher value," the authors write.

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