Developing a client-focused allocation statistic of inpatient nursing resource use: an alternative to the patient day

A sample survey (N = 2660) was conducted at eight acute care hospitals in New Jersey during an 11-month period between 1979 and 1981 in order to develop a client-focused, case-mix sensitive measure of resource use for the allocation of inpatient general nursing costs. Using general linear modelling techniques, the direct and indirect effects of age, length of stay, multiple diagnoses, multiple procedures, the ratio of special care unit days to length of stay and the effects of the presence of surgery, admission status, discharge status and membership in Major Diagnostic Categories on indexed total units of nursing service were explored. The results of the analysis suggested that length of stay is the most significant predictor of indexed nursing units of service regardless of age and the complexity of the medical problem when case-mix is controlled through the assignment of cases to 13 nursing services isoresource clusters. The methodology yields an empirically derived patient-specific, case-mix adjusted length of stay statistic which can be used to apportion nursing costs by the case. The approach permits the estimation of nursing units of service which reflect the relative amount of nursing inputs and corresponding costs of direct patient care consumed by any given inpatient in any given hospital.