Quantification of nursing care and creation of economic indicators: an observational study protocol

The literature on hospital admissions costs shows that classification of hospitalization systems such as the DRG system used in Italy, do not reflect the real cost of the production factors used, including those of nursing care in relation to the complexity of the hospital effort.

This concept paper outlines the study protocol and the methodology used to measure nursing care in economic terms. The objective of the study is developed on the assumption of creating economic indicators from a quantitative analysis of nursing activities provided to specific patients, in order to determine not only who costs but also the reasons for the cost, and demonstrate the variability of nursing not only for DRG, but also each individual patient.

A retrospective study and a longitudinal prospective study will be performed. In the first phase of the study, using a bottom-up Microcosting methodology the type, volume, time and costs of nursing activities for DRG will be determined and the incidence of nursing costs on reimbursement will be highlighted.In the second phase, the above analysis will be supplemented by the recognition of the complexity of individual cases measured through the Corridor Triage(Tri-CO), in order to figure out the incidence of costs of nursing activities on the reimbursement in relation to the level of care complexity. Main sources of data: hospital discharge card (SDO); Professional Assessment Instrument (PAI); datasets for collecting the time of delivery of nursing activities on PAI. Power calculation: For retrospective study, the survey will be conducted on a sample of 150 patients hospitalized in the first quarter of 2016. For the longitudinal prospective study, 150 patients will be included in the first quarter of 2017 after the structured introduction of Tri-CO as a valuation tool of care complexity. The sample examined is approximately 30% of the total number of admissions per year.

The study started in February 2016 and the results are expected for May 2017. Through this study it is expected to verify whether by implementing a unbundling approach, ie the "unpacking" of the production factors (nursing activity costs) used for the explication of hospitalization, and by adopting a methodology based on standard analytical costs, a more detailed knowledge of the overall DRG rate data available today will be obtained, which is currently lacking of explicit notation of all the amounts that make up it.