Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #103922

Ning J. Zhang, MD, PhD, College of Health and Public Affairs, University of Central Florida, 3280 Progress Drive, Orlando, FL 32826, (407) 823-3344, nizhang@mail.ucf.edu, Lynn Unruh, PhD, RN, Health Services Administration Program, University of Central Florida, HPA-2, Rm 210L, Orlando, FL 32816-2200, and Thomas Wan, PhD, College of Health and Public Affairs, Unversity of Central Florida, HPA-1, Orlando, FL 32816-2200.

Research Objective: To explore evidence-based minimum nurse staffing ratios for nursing homes for different quality levels. Study Design: Cross-sectional analyses using multivariate logistic regression and simulation techniques were used. Data were from the On-Line Survey Certification and Reporting System. Quality was measured through an index of incidence rates. Four staffing measures were included. Minimum staffing levels were assessed by a non-linear production function to establish the efficient points at which staffing provides 50, 75 and 90 percent levels of quality. Population Studied: All nursing home facilities federally certified for Medicare and Medicaid and their residents in 2002 and 2003. Principle Findings: Minimum levels of registered nurse hours per resident day were 0.31, 1.83, and 3.3 at three levels of quality respectively. The minimum nursing hours in this study are higher than those suggested by experts. In addition, we estimate the added expense in going from the 50% quality level to 75% as being: $23.51 and $71.07 per resident day for RNs and total nurses, respectively. In an average facility, that would translate to increases in daily expenses of $2,233 for added RNs or $6,751 for added total nurses. Policy Implications: Our study is the first investigation of minimum nurse staffing levels that are efficient and promote quality. It provides evidence-based information for governments to adjust their surveillance and reimbursement policy as well as for nursing home administrators to guide their cost containment, personnel management and quality improvement.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Apply the evidence-based information to guide the cost containment, personnel management and quality improvement.
• Develop the best plan for establishing staffing pool in pursuit of both organizational effciency and quality.
• Evaluate the national and state long term care survillance system and reimbursement policy.

Keywords: Evidence Based Practice, Quality Improvement

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation