Electronic Data Enables Care Evaluation at Individual Nurse Level

Researchers from the University of Michigan, the University and Colorado, and Marquette University have demonstrated differences of individual nurse performance in quality of care, based on individual nurse level data linked to patient-specific outcomes.

"This groundbreaking research, released in a the new issue of Health Services Research featuring the Best of the 2014 Academy Health Annual Research Meeting, lays an empirical foundation for recognizing individual nurses as each being a unique and integral component of care delivery," said University of Michigan officials. "Achieving high-quality patient care and reducing costs will require that high-performing nurses are identified, recognized, and rewarded."

Using electronic data extracted from the 854-bed study, hospital electronic patient records and human resources databases on 1,203 staff nurses were matched with 7,318 adult medical-surgical patients discharged between July 2011 and December 2011. The study employed retrospective observational longitudinal analysis using a covariate-adjustment value-added model with nurse fixed effects.

The aims of the study were to: estimate the relative nurse effectiveness, or individual nurse value-added (NVA), to patients’ clinical condition change during hospitalization; to examine nurse characteristics contributing to NVA; and estimate the contribution of value-added nursing care to patient outcomes.

Principal findings were that nurse effects were jointly significant and explained 7.9 percent of variance in patient clinical condition change during hospitalization. NVA was positively associated with having a baccalaureate degree or higher and expertise level. In addition, NVA contributed to patient outcomes of shorter length of stay and lower costs.

Rather than treating nursing as a commodity, in which “a nurse is a nurse is a nurse,” lead author Olga Yakusheva said her approach opens the door to more meaningful data analysis.

The study is available here.

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