Document Detail


Lower mortality in magnet hospitals.
MedLine Citation:
PMID:  23047129     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although there is evidence that hospitals recognized for nursing excellence--Magnet hospitals--are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why.
OBJECTIVES: To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations. METHOD AND STUDY DESIGN: Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences.
RESULTS: Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76-0.98; P=0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77-1.01; P=0.07) while controlling for nursing factors as well as hospital and patient differences.
CONCLUSIONS: The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes.
Authors:
Matthew D McHugh; Lesly A Kelly; Herbert L Smith; Evan S Wu; Jill M Vanak; Linda H Aiken
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Medical care     Volume:  51     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-11     Completed Date:  2013-06-19     Revised Date:  2014-07-14    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  382-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Clinical Competence
Health Services Research
Hospital Mortality*
Humans
Logistic Models
Nursing Staff, Hospital / education,  standards*
Organizational Culture
Quality of Health Care
United States / epidemiology
Grant Support
ID/Acronym/Agency:
P30 NR005043/NR/NINR NIH HHS; P30-NR-005043/NR/NINR NIH HHS; R01 NR004513/NR/NINR NIH HHS; R01-NR-004513/NR/NINR NIH HHS; R24 HD044964/HD/NICHD NIH HHS; T32 NR007104/NR/NINR NIH HHS; T32-NR007104/NR/NINR NIH HHS
Comments/Corrections
Comment In:
Med Care. 2013 May;51(5):379-81   [PMID:  23552434 ]
Republished in:
J Nurs Adm. 2013 Oct;43(10 Suppl):S4-10   [PMID:  24022082 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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