My Busy SUMR By Egor Buharin
Mentored by Matthew D McHugh, PhD, JD, MPH, RN, CRNP
∗ Continuation of former research and new projects
∗ October, 2010 – Center for Health Outcomes and Policy Research (CHOPR)
∗ Flurry of projects
Interesting Situation
Visual Diagrams – Impact of Nurse Residency Programs
Visual Representation of research
Diagrams
∗ End-of-Life Care: statistical programming ∗ California’s Nurse-to-Patient Mandate
∗ United Arab Emirates – several thousand nurse and
patient surveys.
Projects
∗ Set the scene.
∗ 2,423,995 people died in the U.S. Of these, estimated that 765,651 died in the hospital – 32 percent (2007) ∗ Among the elderly, 31 percent of deaths occurred in the hospital ∗ Approximately 75% of 65+ people have at least one chronic condition
∗ Chronically ill patients often spend their last days in a hospital – society
∗ 50 percent of the conscious patients who die in the hospital have moderate-to-severe pain at least half the time. – New England Journal of Medicine
∗ Passive euthanasia – legal
∗ Hospice
End of Life
• The Costs of End-of-Life Hospitalizations, 2007 - Yafu Zhao, M.S. and William Encinosa, Ph.D • AHRQ - Preventing Disability in the Elderly With Chronic Disease
+50,000,000 observation
∗ 67 to 99 years ∗ full Part A and Part B entitlement throughout the last two years
of life ∗ Persons enrolled in managed care organizations were excluded
from the analysis. ∗ Patients with surgical admissions only were excluded (a patient ∗ whose only hospital admission was for bypass surgery could only
be assigned to ∗ the hospital where the surgery was performed) ∗ based on the first qualifying ∗ ICD-9-CM diagnosis code encountered on the claim closest to
death
Dartmouth – End of Life Trend Report
44 page report: Dartmouth Institute for Health Policy and Clinical Practice
∗ I don’t know what I don’t know
∗ Learning STATA ∗ Learning SAS ∗ Identify all readmissions
associated with the patients that passed during the years of collected data
∗ Combine patient data with hospital data
Experience
∗ Medicare Data ∗ Researchers’
assistance ∗ Resources (forums
and textbooks)
My Struggles My Supports
∗ Beauty of tutorials
∗ Frustration of poor organization / lack of standardization
∗ Importance of efficiency
∗ Value of programmer comments
Lessons Learned / Experience Gained
Claims that a lower patient-to-nurse ratio promotes better patient outcomes
1999 – Legislation signed into law
2002 – Final ratios hospitals would face are released
2004 – Mandate implemented
Background: California’s Nurse Mandate
∗ Linda H. Aiken, PhD, RN; Sean P. Clarke, PhD, RN; Douglas M. Sloane…
∗ Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and
Job Dissatisfaction ∗ each additional patient per nurse was associated with a 7% increase in the
likelihood of dying within 30 days of admission
∗ 7% increase in the odds of failure-to-rescue.
∗ 23% increase in the odds of burnout and a 15% increase in the odds of job dissatisfaction.
Policy
California’s Nurse to Patient Mandate
∗ Magnet Hospitals ∗ Hospital or department closings (not significant)
∗ Public reporting: Nurse to Patient Ratios – increased
competitiveness among hospitals ∗ Lower percentage of skilled nurses (BSN trained): paper
Propelled Research: 2056
∗ California hospitals on average followed
the trend of hospitals nationally by increasing their nursing skill mix, and they primarily used more highly skilled registered nurses to meet the staffing mandate
∗ staffing mandate resulted in roughly an
additional half-hour of nursing per adjusted patient day beyond what would have been expected in the absence of the policy
∗ Lower Medicare Mortality Among a Set of Hospitals Known for Good Nursing Care – Magnet Hospital have 9.4 fewer deaths per 1000 patients
∗ My part; literary reviews
California’s Nurse-to-Patient Mandate
∗ Inside the head of a researcher
∗ Discuss inherent problems
∗ Search for solutions
∗ Be part of the developmental processes
Tremendous Gain
∗ Established as a country in 1973
∗ 30% of world’s cranes in Dubai – 2008
∗ The UAE is classified as a high-income developing economy by the International Monetary Fund.
∗ A high per-capita nominal GDP of US$47,407 for the last fiscal year.
United Arab Emirates
∗ Monday, May 10th, 2010
∗ Dr. Lauren Arnold - consultant to the UAE Ministry of Health and Executive Director of the newly formed UAE Council on Nursing
∗ Operates out of the Office of Her Royal Highness Princess Haya
Dubai
∗ Ghada Sherry. Ghada is Head of practice Development Section,
Federal Department of Nursing, Ministry of Health ∗ Deputy Minister ∗ Dr. Fatima Rafai, Chief Nurse of UAE ∗ Dr. Linda Aiken ∗ Dr. Hanif Al Qassimi, Minister of Health for United Arab Emirates ∗ Dr. Lauren Arnold
∗ 30 general hospitals of over 100 beds in the UAE
∗ EU research protocol surveying nurses and patients
∗ Grant from Emirates Foundation and the Ministry
∗ Nursing survey - 8 pages, 15 questions each.
The Surveys
∗ Use empirical data to sculpt a modern healthcare system
∗ Very malleable – as oppose to the healthcare system of the United States
∗ Create a international model
Intent
∗ First – skim through packets searching for excessive mistakes.
∗ Interesting findings from first glance: Nurses were eager to vent.
∗ Physical and verbal abuse from patients, patients’ families, and superiors – Very Dissatisfied
Coding
∗ Properly construct survey ∗ Typos ∗ Leave no room to wiggle ∗ BASIC
∗ Importance of automated coding ∗ Countless work-hours ∗ Time consuming labor
Technical Lessons
∗ Matthew D McHugh, PhD, JD, MPH, RN, CRNP
∗ All personnel and faculty that make SUMR possible
∗ SUMR Scholars
Appreciation