RELATIONSHIPS BETWEEN MEDICAL CONDITION, NURSING CONDITION, NURSING INTENSITY, MEDICAL SEVERITY AND LENGTH-OF-STAY IN HOSPITALIZED MEDICAL-SURGICAL ADULTS USING THE THEORY OF SOCIAL ORGANIZATIONS AS ADAPTIVE SYSTEMS.
Contributors: Wayne State University.
Published: 1990
Number of pages: 188
Subjects: Health Sciences, Nursing.
Description: Diagnosis-related-groups (DRGs) are predicated on the assumption that they classify patients with similar patterns of consumption of hospital services including nursing care as well as medical treatment. Presumably, patients within a DRG should only consume hospital resources and have length-of-stays that match a predetermined government allocation. The purpose of this study was to determine the explanatory power of medical condition, nursing condition, nursing intensity, and medical severity for length-of-stay.

To study this problem a Theory of Social Organizations as Adaptive Systems was derived from the Roy Adaptation Model. Hypotheses and questions were developed to identify determinants of resource consumption that explained length-of-stay. The predictor variables of medical condition, nursing condition, nursing intensity, and medical severity were viewed as stimuli for the coping subsystems of stabilizer and innovator. One stabilizer structure was the management information system and an innovator structure was administrative meetings. Information is processed, interpreted, and manifested in the physical adaptive system mode as information about the criterion variable, length-of-stay.

In this ex post facto correlational design 1,000 hospital records were randomly sampled of patients discharged under 1 of 10 DRGs in a Midwestern hospital. A sample of 973 patient records was used.

Findings indicated that 19 percent of the total explained variance (23%) in length-of-stay, a major determinant of hospital costs, was explained by measures of nursing care, i.e., hours of care and nursing diagnoses. This study demonstrated, albeit in a limited fashion, that neither measures of medical condition nor measures of medical severity were a substitute for measures of nursing care.

The current DRG methodology does not consider: severity of illness, functional deficits caused by the debilitating effects of medical treatment, and aging, or the co-existence of conditions unrelated or indirectly related to the discharge DRG. These factors may require additional hospital resources including nursing care. Thus, nursing care needs to be considered in schemes that shape hospital reimbursement policy. Moreover, this study demonstrates the utility of the Theory of Social Organizations as Adaptive Systems for the conduct of research in nursing administration.
Notes: Source: Dissertation Abstracts International, Volume: 52-03, Section: B, page: 1354.

Thesis (PH.D.)--WAYNE STATE UNIVERSITY, 1990.

School code: 0254.