Staffing SAFER - State Analysis for Effective Reporting

Project Details


Project Summary/Abstract Decades of outcomes research have demonstrated a significant relationship between nurse staffing and patient quality. As a result of this research, the Registered Nurse Safe Staffing Act (H.R.2083/S.1132) was introduced in the 114th Congress in April 2015, requiring Medicare-participating hospitals to publicly report patient to nurse staffing ratios on the Medicare website HospitalCompare. Additionally, 14 states have enacted laws 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 reporting requirements. 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 only state that mandates minimum nurse-to-patient ratios throughout the hospital (MA recently passed ratios for ICUs only). While research has documented that improved staffing in CA resulted from mandated ratios, and some evidence suggests that this increase has resulted in better patient outcomes, most states have been reluctant to adopt mandated ratios. An alternative policy design, adopted by a small number of states, requires hospitals to publicly report nurse staffing levels. As yet, no empirical evaluation of the effectiveness of these policies for improving staffing and skill mix have been reported. The purpose of this proposal is to evaluate the effectiveness of legislation in New Jersey (NJ), a state that requires hospitals to publicly report nurse staffing. Guided by Jonathan Kolstad's economic theory of quality reporting and demand, which posits that demand is determined by a set of informed consumers (i.e., patients, hospital managers, and health care providers), this proposal hypothesizes that public reporting of staffing levels will lead to better nurse staffing and skill mix in hospitals [1]. This resubmission evaluates the effect of the NJ public reporting law and whether hospital nurse staffing and skill mix improved in response to the legislation. This possible change in staffing and skill mix will be compared to hospitals in a state 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 and comprehensive nurse survey; and 2) the American Hospital Association (AHA) Annual Hospital Survey. Analyses will employ segmented regression analysis of interrupted time series and propensity scoring matching. 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 of current strengths and weaknesses of existing policy approaches. Career Development Training Plan: The purpose of this K08 Mentored Clinical Scientist Award is to facilitate the applicant's development as an independent researcher while preparing her for a successful health services research career. The development plan is specifically designed to gain skills in policy research, including engaging stakeholders, writing policy memos, communicating with the media, and disseminating findings to legislators and the scientific community. This will be achieved by mentorship from exceptional mentors in economics and policy research as well as formal coursework. My long-term goals of this proposal are to disseminate the evaluation of public reporting of staffing in policy venues and develop an R01 application assessing 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: $160,845.00


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