The Patient-level Nursing Cost Estimation and Associated Factors Using Big Health Data
Creators: name: Lee, Seo-Yoon
Publisher: name: University of Illinois at Chicago
Year: 2024

description: Historically, since Social Security Act enactment, nursing costs in hospital acute systems were embedded in the room and board charges and never separated, which makes it difficult to extract the true value of nursing care in the acute hospital system. Nursing costs have been studied with the introduction of every new reimbursement system but continue to be part of room and board charges. Currently, nursing cost is estimated at the unit level. To estimate each patient’s nursing costs, the aggregated costs across the unit would be distributed equally to each patient. However, this approach may overshadow the variability and complexity of nursing demands, as well as the expertise and preparation of each nurse. As nursing care become more complex end and health reimbursement models transition to Value-Based models (i.e., considers patient’s outcomes as part of reimbursement mechanisms), having nursing costs at an individual level would change the paradigm of how nursing care is valued in healthcare setting. To better measure and quantify the value of nursing, the contribution of each nurse must be identified4. A major barrier in identifying nursing costs at an individual level was the lack of tools to measure and monitor the contributions of nursing staff or how nursing services contribute to individual patient health outcomes. To overcome this gap, Welton &amp; Harper developed the Nursing Value Data Framework Model (i.e., Nursing Value Model) 4.
The Nursing Value Model is a dataset model developed to measure the value of nursing care at the patient level. The Nursing Value Model for this project was constructed by multiple datasets that were extracted and assembled from various sources, such as the hospital Electronic Health Records (EHR) and administrative data. This model has only been examined in some hospitals in the United States. Value-based care in reimbursement models highlight the importance of identifying nursing care factors that relates to patient outcomes. This pilot study was conducted to explore the process of constructing a Nursing Value Model and to identify significant factors with the patient-level nursing costs and the percent of room charges attributed to nursing care, specifically registered nursing care. In the first paper, the Principal Investigator (PI) explored the process used to construct the Nursing Value Model using available healthcare data and the insights and pitfalls encountered during the development of the model. The second paper focused on estimating the patient-level nursing costs, exploring the percent of room charge attributed to nursing, and identifying significant factors associated with these costs.
Specifically, for the first study, the PI collected six datasets from four data sources that are available in University of Illinois (UI) Health. Six datasets from four different data sources were collected and merged constructing the Nursing Value Model. The compatibility of Nurse Patient Assessment System (NPAS) data with other datasets was a key factor when constructing the model. Several inconsistencies in study participant's identification across the datasets were identified. This result provides an insight that if nursing value of each patient needs to be computed, systems need to be developed that are specifically designed to collect, organize, and synthesize data easily. With the Nursing Value Model constructed in the first study, the PI estimated the patient-level nursing costs and its percentage of room charge and identified the factors that are significantly related to the patient-level nursing costs and the percent of room charge attributed to nursing care. A total of 356 patients and 101 nurses were involved during the study period of January 30 to July 30, 2022. Analytical results in both bivariate and multivariate analyses for the data collected showed that acuity, length of stay, Medicare Severity Diagnosis
Related Groups (MS-DRG) groupings, nurses’ length of experience, and the number of patients that nurses took care of in each shift were identified as significant factors of the patient-level nursing costs and percent of room charge attributed to nursing care.
In conclusion, this pilot study showed that it is feasible to estimate nursing costs at an individual patient level. However, the process is very complex, and several limitations were noted which should be addressed in future studies. Even though there are limitations, this pilot study showed that the estimated patient-level nursing costs and the percent of room charge reflects similar to where nursing demand was required.