Magnet hospital status impact on mortality, readmission, and patient reported quality of care .

摘要

Healthcare errors are among the top ten causes of death in the United States (U.S.) (Institute of Medicine (IOM), 2000). The IOM (2000) estimated that 44,000- 98,000 people die each year in the U.S. due to healthcare errors. According to the statistics revealed in the most recent Healthgrades report Patient Safety and Satisfaction: The State of American Hospitals (2012), healthcare in the U.S. still has not made sufficient changes to improve patient safety. With more than 3.1 million nurses in the U.S., the profession of nursing makes up the largest health care body in the nation (Health Resources and Services Administration (HRSA), 2010). With such a large presence at the bedside, it is evident that nurses are essential in improving the quality and safety of patient care. One popular nurse focused initiative to improve patient care is the Magnet Recognition Program.;The Magnet Recognition Program was designed to recognize facilities that are successful at recruiting and retaining nurses due to optimal nurse work environments. Ample research exists to conclude that Magnet Hospitals do provide improved nurse outcomes and nurse work environments. However insufficient and inconsistent evidence exists to support current claims that Magnet hospitals are the “Gold Standard” or provide the “Best Quality Patient Care” (ANCC, 2012d; Kramer & Schmalenberg, 2005). The purpose of this study was to determine if significant relationships exists between the Magnet status of hospitals 30-day mortality and readmission rates (for myocardial infarctions (MIs), congestive heart failure (CHF), and pneumonia); and patient reported quality of care measures. Additional hospital characteristics what were investigated included teaching affiliation, control/ownership, bed size, and geographical location.;This study was a secondary data analysis of Magnet, Magnet-in-progress, and non-Magnet hospitals (N=2001) from throughout the U.S. The data was collected by the Centers of Medicare and Medicare Services from July 1, 2008 to June 30, 2011 for 30- day mortality and readmission rates for MIs, CHF, and pneumonia; and from January 1, 2011 to December 31, 2011 for patient reported quality of care measures. Univariable and multivariable analysis methodologies were utilized to determine which hospital characteristics had significant relationships with the patient outcomes investigated.;Univariable analysis revealed that 30 day mortality rates for MIs were found to be significantly lower (p < 0.001) in Magnet hospitals (14.87) than in non-Magnet hospitals (15.43). On multivariable analysis, Magnet status was not identified as having a significant linear relationship with 30-day mortality and readmission rates for MIs, CHF, and pneumonia. The remaining hospital characteristics investigated demonstrated varied results depending on the outcome measures investigated. Magnet and Magnet-inprogress hospitals were found to have significantly (p < 0.007) higher scores than non- Magnet hospitals on six of the seven subjective outcome variables investigated regarding patient reported satisfaction with care. The remaining subjective outcome variable did show higher scores in Magnet and Magnet-in-progress hospitals as well, but the findings were not found to be statistically significant.;The implication of these results for nursing practice, policy, and future research are discussed. Pursuits of Magnet status for hospitals driven by the claims to provide better objective patient outcomes are not well supported by current research. However, with the new Medicare Value-Based Purchasing (VBP) Program, 30% of hospital’s reimbursement will be determined based on the measures included in this study regarding patient reported satisfaction with care. Therefore, improving patient satisfaction scores may be a promising angle for the Magnet Recognition Program.