Staffing SAFER - State Analysis for Effective Reporting

Project Details


Project Summary/Abstract Decades of outcomes research have demonstrated a significant relationship between nurse staffing andpatient quality. As a result of this research, the Registered Nurse Safe Staffing Act (H.R.2083/S.1132) wasintroduced in the 114th Congress in April 2015, requiring Medicare-participating hospitals to publicly reportpatient to nurse staffing ratios on the Medicare website HospitalCompare. Additionally, 14 states have enactedlaws aimed at improving nurse staffing. These laws include minimum nurse-to-patient ratio mandates,requirements for hospitals to have staffing plans developed by staffing committees, and/or public reportingrequirements. Although some of these state staffing laws have been in place since 2002, there has been little,if any, research evaluating the effectiveness of these laws, with the exception of California (CA) the onlystate that mandates minimum nurse-to-patient ratios throughout the hospital (MA recently passed ratios forICUs only). While research has documented that improved staffing in CA resulted from mandated ratios, andsome evidence suggests that this increase has resulted in better patient outcomes, most states have beenreluctant to adopt mandated ratios.An alternative policy design, adopted by a small number of states, requires hospitals to publicly report nursestaffing levels. As yet, no empirical evaluation of the effectiveness of these policies for improving staffing andskill mix have been reported. The purpose of this proposal is to evaluate the effectiveness of legislation in NewJersey (NJ), a state that requires hospitals to publicly report nurse staffing. Guided by Jonathan Kolstad'seconomic theory of quality reporting and demand, which posits that demand is determined by a set of informedconsumers (i.e., patients, hospital managers, and health care providers), this proposal hypothesizes that publicreporting of staffing levels will lead to better nurse staffing and skill mix in hospitals [1]. This resubmissionevaluates the effect of the NJ public reporting law and whether hospital nurse staffing and skill mix improved inresponse to the legislation. This possible change in staffing and skill mix will be compared to hospitals in astate with more stringent legislation of a nurse-to-patient ratio (CA) and a state without any staffing legislation(PA). The analysis will use two datasets for 3 states at 2 points in time 2006 and 2015: 1) a unique andcomprehensive nurse survey; and 2) the American Hospital Association (AHA) Annual Hospital Survey.Analyses will employ segmented regression analysis of interrupted time series and propensity scoringmatching. This proposal is central to AHRQ's mission of improving the quality and safety of US health care.Understanding the effect of state-mandated staffing policies can inform researchers and policy makers ofcurrent strengths and weaknesses of existing policy approaches.Career Development Training Plan: The purpose of this K08 MentoredClinical Scientist Award is to facilitatethe applicant's development as an independent researcher while preparing her for a successful health servicesresearch career. The development plan is specifically designed to gain skills in policy research, includingengaging stakeholders, writing policy memos, communicating with the media, and disseminating findings tolegislators and the scientific community. This will be achieved by mentorship from exceptional mentors ineconomics and policy research as well as formal coursework. My long-term goals of this proposal are todisseminate the evaluation of public reporting of staffing in policy venues and develop an R01 applicationassessing the effects of staffing legislation on financing and quality patient outcomes.
Effective start/end date8/1/167/31/20


  • Agency for Healthcare Research and Quality: $161,219.00


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