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The staffing-outcomes relationship in nursing homes
R Tamara Konetzka1, Sally C Stearns, Jeongyoung Park
1University of Chicago, Department of Health Studies, 5841 S. Maryland Avenue, MC2007, Chicago, IL 60637, USA.
Health Services Research
|May 6, 2008
Summary
Increased registered nurse (RN) staffing in nursing homes significantly reduces adverse resident outcomes like pressure sores and infections. Accounting for staffing endogeneity reveals greater benefits of higher RN staffing levels.
Area of Science:
- Gerontology
- Health Services Research
- Nursing
Background:
- Nursing home resident outcomes are influenced by staffing levels and skill mix.
- The relationship between staffing and outcomes may be endogenous, potentially biasing estimates.
- Understanding this relationship is crucial for quality improvement in long-term care.
Purpose of the Study:
- To longitudinally assess the impact of registered nurse (RN) staffing and skill mix on nursing home resident outcomes.
- To control for the potential endogeneity of staffing in the analysis.
- To examine the effects on pressure sore and urinary tract infection incidence.
Main Methods:
- Longitudinal resident-level analysis using Minimum Data Set (MDS) and Online Survey Certification and Reporting (OSCAR) data (1996-2000).
- Employed facility fixed effects and instrumental variables to address endogeneity.
- Measured RN staffing as care hours per resident-day and skill mix as the proportion of RN hours.
Main Results:
- Controlling for endogeneity amplified the estimated impact of staffing on resident outcomes.
- Higher registered nurse (RN) staffing levels significantly reduced the likelihood of both pressure sores and urinary tract infections.
- Increased skill mix, specifically higher RN proportion, was associated with a reduction in urinary tract infections only.
Conclusions:
- Studies not accounting for staffing endogeneity may underestimate the benefits of increased registered nurse (RN) staffing.
- Enhanced RN staffing is likely to decrease adverse outcomes in nursing home residents.
- Further research with broader instruments and national data is recommended.
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