Learning Objective #1: The learner will be able to: identify 1 structural and 1 financial variable related to mortality in acute-care hospitals

Learning Objective #2: The learner will be able to: state the significance of 1 structural and 1 financial variable related to mortality in acute-care hospitals

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Introduction and Statement of the Problem Despite measureable gains in patient safety and quality improvement processes in United States hospitals, numerous questions remain about the value of improving care from both societal and hospital perspectives. The problem is: there may not be the business case for quality as was formerly thought. In partial answer to this, a study was undertaken to examine the influence, of hospital attributes on risk-adjusted hospital mortality.

Purpose and Research Question: The purpose of the study was to describe and evaluate the contributions of structural and financial characteristics to the variation in inter-hospital risk-adjusted mortality. The research question was: What are the contributions of financial and structural characteristics to the variation in risk-adjusted hospital mortality from Community-Acquired Pneumonia (CAP) in California Acute-Care for FY (Fiscal Years) 2002-2004? The outcome variable of interest, CAP mortality rates, was chosen for utility—CAP is a frequent and costly condition in California, the U. S. and throughout the world.

Method and Data Sources In a purposive sample of 390 hospitals reporting risk-adjusted CAP-mortality to the Office of Statewide Health Planning & Development (OSHPD), an ex post-facto correlational design tested associations of the following: teaching status, percentage of board-certified physicians, Registered Nurse (RN) hours/pt. day (pt. day), volume of CAP cases, technological resources, location, profit status, and operating expenses per patient day. Five sources of public data were used including OSHPD's Hospital Financial Disclosure File.

Main Results In the model which explained 15% of the variation in mortality (p < .001), positive associations were found for profit status (Investor-owned hospitals had higher CAP mortality), teaching status, volume of cases and RN hours/pt. day. Most striking was: when holding all else constant*, RN hours/pt. day (p = .005) was inversely related to mortality.

Conclusions The results contribute to the body of knowledge about the alleged cost/quality (value) tradeoff in hospital management practices. Whether RN staffing should increase depends on the view of stakeholders, chiefly, the nurse executive and society as a whole. The study was funded by Sigma Theta Tau International's Gamma Tau chapter.