DETERMINANTS OF NURSING CARE COSTS AND PATIENT OUTCOMES

本提案的总体目标是描述选定的病人和

The overall objective of this proposal is to describe selected patient and structural characteristics that influence the cost of nursing care in community hospitals. Specific aims are: (1) to determine how total nursing cost of a hospital stay is predicted by patient characteristics (DRG, nursing diagnoses, severity of illness, age, and method of payment) nursing staff and physician characteristics; (2) to determine how patient outcomes (dependency, adjusted LOS, adverse incidents, satisfaction with nursing care and self care knowledge) are predicted by patient, nursing staff and physician characteristics; and (3) to determine if patient outcomes are predicted by cost of nursing care. A method for determining nursing costs was developed by Higgerson and Van Slyck in the early 1970's (Higgerson & Van Slyck, 1982). Using a patient classification system that produces patient care units (PCU) based on the nursing process, direct costs of providing nursing care are determined. Indirect costs are allocated from other hospital cost centers to arrive at a total nursing cost. The method has been modified to reflect current nursing practice and costs and adopted for use in twelve Midwestern hospitals, four of which have agreed to participate in this study. A sample size of 200 subjects in each of 10 high volume DRGs is projected. The analytic approach to the data will be a multiple regression framework in which the dependent variable will be either a measure of nursing cost or patient outcome.