Nursing: a major hospital cost component.

Area of Science:

• Healthcare Management
• Nursing Economics
• Health Services Research

Background:

• Nursing costs per patient-day and per patient stay exhibit wide variations within the same Diagnosis-Related Group (DRG).
• These cost discrepancies may stem from genuine differences in nursing practice or from divergent methodologies used in cost calculation.

Purpose of the Study:

• To investigate alternative methods for determining hospital nursing costs for a consistent patient cohort.
• To compare various patient illness measures and nursing cost definitions to identify sources of cost variability.

Main Methods:

• Compared patient illness measures: AS-SCORE severity of illness, Relative Intensity Measures (RIMs), MacLeod nursing intensity, and a per diem measure.
• Evaluated different definitions of nursing cost, including approaches by nursing unit and by hands-on patient care.
• Analyzed nursing cost data for DRG 121 (myocardial infarction) from multiple studies and compared it with the study's findings.

Main Results:

• Significant variations in nursing care costs per patient stay were observed across different studies for DRG 121, ranging from $706 to $1,778 (a 60% difference).
• Methodological differences in cost calculation appear to be a substantial contributor to the observed variability in nursing costs.
• The study highlights the impact of both patient acuity measures and cost-defining approaches on reported nursing expenditures.

Conclusions:

• Methodological inconsistencies are a primary driver of the wide variation in reported nursing costs across studies.
• Standardized measures and cost-finding methodologies are essential for reliable comparisons of nursing costs.
• Future nursing cost research should prioritize the development and adoption of comparable analytical frameworks.