IDEAS home Printed from https://ideas.repec.org/a/spr/eujhec/v22y2021i5d10.1007_s10198-021-01292-2.html
   My bibliography  Save this article

The impact of nurse staffing levels on nursing-sensitive patient outcomes: a multilevel regression approach

Author

Listed:
  • Karina Dietermann

    (University of Hamburg)

  • Vera Winter

    (University of Wuppertal)

  • Udo Schneider

    (Health Care Management at Techniker Krankenkasse)

  • Jonas Schreyögg

    (University of Hamburg)

Abstract

The goal of this study is to provide empirical evidence of the impact of nurse staffing levels on seven nursing-sensitive patient outcomes (NSPOs) at the hospital unit level. Combining a very large set of claims data from a German health insurer with mandatory quality reports published by every hospital in Germany, our data set comprises approximately 3.2 million hospital stays in more than 900 hospitals over a period of 5 years. Accounting for the grouping structure of our data (i.e., patients grouped in unit types), we estimate cross-sectional, two-level generalized linear mixed models (GLMMs) with inpatient cases at level 1 and units types (e.g., internal medicine, geriatrics) at level 2. Our regressions yield 32 significant results in the expected direction. We find that differentiating between unit types using a multilevel regression approach and including postdischarge NSPOs adds important insights to our understanding of the relationship between nurse staffing levels and NSPOs. Extending our main model by categorizing inpatient cases according to their clinical complexity, we are able to rule out hidden effects beyond the level of unit types.

Suggested Citation

  • Karina Dietermann & Vera Winter & Udo Schneider & Jonas Schreyögg, 2021. "The impact of nurse staffing levels on nursing-sensitive patient outcomes: a multilevel regression approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(5), pages 833-846, July.
    • Handle: RePEc:spr:eujhec:v:22:y:2021:i:5:d:10.1007_s10198-021-01292-2
    DOI: 10.1007/s10198-021-01292-2
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10198-021-01292-2
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10198-021-01292-2?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Barbara A. Mark & David W. Harless & Michael McCue, 2005. "The impact of HMO penetration on the relationship between nurse staffing and quality," Health Economics, John Wiley & Sons, Ltd., vol. 14(7), pages 737-753, July.
    2. Andrew Bell & Malcolm Fairbrother & Kelvyn Jones, 2019. "Fixed and random effects models: making an informed choice," Quality & Quantity: International Journal of Methodology, Springer, vol. 53(2), pages 1051-1074, March.
    3. Cook, Andrew & Gaynor, Martin & Stephens Jr, Melvin & Taylor, Lowell, 2012. "The effect of a hospital nurse staffing mandate on patient health outcomes: Evidence from California's minimum staffing regulation," Journal of Health Economics, Elsevier, vol. 31(2), pages 340-348.
    4. Mareike Heimeshoff & Jonas Schreyögg & Oliver Tiemann, 2014. "Employment effects of hospital privatization in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(7), pages 747-757, September.
    5. Augurzky, Boris & Bünnings, Christian & Wübker, Ansgar, 2017. "The relationship between nurse staffing levels and objective and subjective quality of care: A panel data approach for Germany," Ruhr Economic Papers 724, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    6. Milstein, Ricarda & Schreyoegg, Jonas, 2020. "The relationship between nurse staffing levels and nursing-sensitive outcomes in hospitals: Assessing heterogeneity among unit and outcome types," Health Policy, Elsevier, vol. 124(10), pages 1056-1063.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. John R. Bowblis & Andrew Ghattas, 2017. "The Impact of Minimum Quality Standard Regulations on Nursing Home Staffing, Quality, and Exit Decisions," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 50(1), pages 43-68, February.
    2. KonShik Kim, 2023. "The impact of job quality on organizational commitment and job satisfaction: The moderating role of socioeconomic status," Economic and Industrial Democracy, Department of Economic History, Uppsala University, Sweden, vol. 44(3), pages 773-797, August.
    3. Baron, Opher & Callen, Jeffrey L. & Segal, Dan, 2023. "Does the bullwhip matter economically? A cross-sectional firm-level analysis," International Journal of Production Economics, Elsevier, vol. 259(C).
    4. Gabriel A. Facchini Palma, 2020. "Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon," Working Papers wpdea2009, Department of Applied Economics at Universitat Autonoma of Barcelona.
    5. Joshua D. Gottlieb & Avi Zenilman, 2020. "When Workers Travel: Nursing Supply During COVID-19 Surges," NBER Working Papers 28240, National Bureau of Economic Research, Inc.
    6. Mareike Heimeshoff & Jonas Schreyögg & Oliver Tiemann, 2014. "Employment effects of hospital privatization in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(7), pages 747-757, September.
    7. Scherr, Sebastian & Reifegerste, Doreen & Arendt, Florian & van Weert, Julia C.M. & Alden, Dana L., 2022. "Family involvement in medical decision making in Europe and the United States: A replication and extension in five Countries," Social Science & Medicine, Elsevier, vol. 301(C).
    8. Cristina Borra & Jerònia Pons-Pons & Margarita Vilar-Rodríguez, 2020. "Austerity, healthcare provision, and health outcomes in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 409-423, April.
    9. Nick Drydakis, 2023. "Parental unemployment and adolescents' academic performance," International Journal of Manpower, Emerald Group Publishing Limited, vol. 44(7), pages 1362-1381, February.
    10. Yana Akhtyrska & Franz Fuerst, 2021. "People or Systems: Does Productivity Enhancement Matter More than Energy Management in LEED Certified Buildings?," Sustainability, MDPI, vol. 13(24), pages 1-35, December.
    11. Welsch, Heinz, 2021. "How climate-friendly behavior relates to moral identity and identity-protective cognition: Evidence from the European social surveys," Ecological Economics, Elsevier, vol. 185(C).
    12. Chowdhury, Subhasish M. & Crede, Carsten J., 2020. "Post-cartel tacit collusion: Determinants, consequences, and prevention," International Journal of Industrial Organization, Elsevier, vol. 70(C).
    13. Amez, Simon & Baert, Stijn & Heydencamp, Emily & Wuyts, Joey, 2021. "Does Multitasking Affect Students' Academic Performance? Evidence From a Longitudinal Study," GLO Discussion Paper Series 982, Global Labor Organization (GLO).
    14. Rudolph, Maximilian & Starke, Peter, 2020. "How does the welfare state reduce crime? The effect of program characteristics and decommodification across 18 OECD-countries," Journal of Criminal Justice, Elsevier, vol. 68(C).
    15. Toger, Marina & Türk, Umut & Östh, John & Kourtit, Karima & Nijkamp, Peter, 2023. "Inequality in leisure mobility: An analysis of activity space segregation spectra in the Stockholm conurbation," Journal of Transport Geography, Elsevier, vol. 111(C).
    16. Grzegorz Zimon & Andrea Appolloni & Hossein Tarighi & Seyedmohammadali Shahmohammadi & Ebrahim Daneshpou, 2021. "Earnings Management, Related Party Transactions and Corporate Performance: The Moderating Role of Internal Control," Risks, MDPI, vol. 9(8), pages 1-26, August.
    17. Patrizia Pastore & Antonio Ricciardi & Silvia Tommaso, 2020. "Contractual networks: an organizational model to reduce the competitive disadvantage of small and medium enterprises (SMEs) in Europe’s less developed regions. A survey in southern Italy," International Entrepreneurship and Management Journal, Springer, vol. 16(4), pages 1503-1535, December.
    18. Salm, Martin & Wübker, Ansgar, 2018. "Do higher hospital reimbursement prices improve quality of care?," Ruhr Economic Papers 779, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    19. Sadeq Damrah & Mohammad I. Elian & Mohamad Atyeh & Fekri Ali Shawtari & Ahmed Bani-Mustafa, 2023. "A Linear Mixed Model Approach for Determining the Effect of Financial Inclusion on Bank Stability: Comparative Empirical Evidence for Islamic and Conventional Banks in Kuwait," Mathematics, MDPI, vol. 11(7), pages 1-17, April.
    20. Jonathan Mukiza Peter Kansheba & Mutaju Isack Marobhe, 2022. "Institutional quality and resource-based economic sustainability: the mediation effects of resource governance," SN Business & Economics, Springer, vol. 2(2), pages 1-24, February.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:eujhec:v:22:y:2021:i:5:d:10.1007_s10198-021-01292-2. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.