PREDICTORS OF NURSING RESOURCE USE FOR DIRECT PATIENT CARE IN A HOSPITAL-BASED OUTPATIENT CLINIC.
Contributors: University of Iowa.
Published: 1995
Number of pages: 253
Subjects: Health Sciences, Nursing.; Economics, Theory.; Health Sciences, Health Care Management.
Description: Over the past decade increased utilization of, and expenditures for outpatient services have intensified the interest in implementing a prospective payment system in this setting. These payment systems rely on physician resource use as a proxy for nursing resource use as nursing resource use has not been extensively researched.

This study was conducted to determine the variables that predict nursing resource use for direct patient care in an outpatient setting. The variables included those identified in the Andersen-Newman Model, which relates health care utilization to predisposing, enabling, and need factors, and physician variables. A whole population sample of 375 subjects, from three medical specialties, was selected.

Using a cross-sectional, correlational design, data were obtained from 1991 secondary data sources: a utilization and patient flow study, medical record, and computer visit data. Nursing resource use was measured as minutes of nursing time to provide direct patient care inclusive, and exclusive of time to perform procedures/treatments. Data for nursing and physician time were obtained from the patient flow study. The other sources provided data for the remaining variables.

Multiple regression analyses revealed that no unique group of variables predicted nursing resource use as the significance of the variables changed across the medical specialties. In the total sample, 13.7% variance in nursing time, excluding procedure/treatment time, was accounted for (9.8% to 22.1% in the specialty groups). The variance increased to 73.3% for the total sample when procedure/treatment time was added (44.3% to 74.8% in the specialty groups). Need factors, especially treatments, were the best predictors of nursing resource use.

The explained variance in nursing time was similar when Ambulatory Patient Group variables were used. Physician factors were not significant predictors suggesting that they are poor proxies for nursing resource use.

When procedures/treatments were not performed, $>$80% of the variance in nursing time remained unaccounted for by the Andersen-Newman Model and Ambulatory Patient Groups. These findings have implications for the development of a prospective payment system, and further research of nursing interventions that account for the variance in nursing resource use.
Notes: Source: Dissertation Abstracts International, Volume: 56-06, Section: B, page: 3130.

Thesis (PH.D.)--THE UNIVERSITY OF IOWA, 1995.

School code: 0096.