The Impact of Within-Nursing
Unit Variation in Patient Care
Hours on Post-Discharge
Utilization and Costs
Kathleen Bobay, PhD, RN
Olga Yakusheva, PhD
Marianne Weiss, DNSc, RN
Jane Nosbusch, PhD, RN
Aims of the Study

(1) examine the direct relationship between
nurse practice environment and postdischarge readmission and ED utilization

(2) develop a model for estimating and
optimizing cost and benefits of modifying the
nurse practice environment to impact postdischarge utilization
Study Design

Nested multi-level predictive model
 Patient
level nested within unit level nested within
hospitals

Panel data analysis (within-unit, over-time)
strengthens causal inference

Cost-optimization modeling of changes to the
nurse practice environment
Sample

Within unit random selection of 1760 patients meeting
study eligibility criteria

16 medical-surgical units in 4 Magnet-designated
hospitals in 1 health system in Midwestern US


1/01/07 through 6/30/07
Valid cases = 1660
Results: HPPD and Unplanned
Related Post-DC Utilization
Cost-Benefit Analysis

Cost Benefit Analysis of adding 1 HPPD
 Net
loss for hospital:
Lost revenue from fewer ED visits and Increased
staffing costs
 Net
benefit for payor:
Reduction in hospital and physician payments due to
fewer ED visits
Results: Cost-Benefit Analysis
Financial Impact of Increased Staffing
(per hospitalized patient)
Hospital
+1 RN_HPPD
Total Financial Impact
+1 Non-RN_HPPD
Total Financial Impact
Payor
Patient
Revenue
Staffing
costs
Hospital
Payment
Physician
Payment
-2.36
+209.86
-14.75
-1.44
-212.22
-2.38
+143.36
-145.74
+16.19
-14.9
-1.44
+16.34
Policy Implications
Increasing HPPD could result in cost
savings for payors
 Disincentive for hospitals to increase
HPPD

Cost
Reim bursem ent
ED Visit
513
559
Future Research

Expand to include other hospitals (nonMagnet) and other health systems

Tracking patients between health systems

System level variables
Questions

Contact information:
 Kathleen
Bobay
 Kathleen.bobay@marquette.edu
 (414) 288-3851