Southwest Journal of Pulmonary and Critical Care (Apr 2012)
Correlation between patient outcomes and clinical costs in the va healthcare system
Abstract
Introduction: Increased nursing staffing levels have previously been associated with improved patient outcomes. However, the effects of physician staffing and other clinical care costs on clinical outcomes are unknown.Methods: Databases from the Department of Veterans Affairs were searched for clinical outcome data including 30-day standardized mortality rate (SMR), observed minus expected length of stay (OMELOS) and readmission rate. These were correlated with costs including total, drug, lab, radiology, physician (MD), and registered nurse (RN), other clinical personnel costs and non-direct care costs.Results: Relevant data were obtained from 105 medical centers. Higher total costs correlated with lower intensive care unit (ICU) SMR (r=-0.2779, p<0.05) but not acute care (hospital) SMR. Higher costs for lab, radiology, MD and other direct care staff costs and total direct care costs correlated with lower ICU and acute care SMR (p<0.05, all comparisons). Higher RN costs correlated only with ICU SMR. None of the clinical care costs correlated with ICU or acute care OMELOS with the exception of higher MD costs correlating with longer OMELOS. Higher clinical costs correlated with higher readmission rates (p<0.05, all comparisons). Nonclinical care costs (total costs minus direct clinical care costs) did not correlate with any outcome.Conclusions: Monies spent on clinical care generally improve SMR. Monies spent on nonclinical care generally do not correlate with outcomes.
