To determine whether, following implementation of alifornia's minimum nurse staffing legislation, changes in acuity‐adjusted nurse staffing and quality of care in alifornia hospitals outpaced similar changes in hospitals in comparison states without such regulations.
Data Sources/Study Setting
Data from the merican ospital ssociation nnual urvey of ospitals, the alifornia ffice of tatewide ealth lanning and evelopment, the ospital ost eport nformation ystem, and the gency for ealthcare esearch and uality's ealth are ost and tilization roject's tate npatient atabases from 2000 to 2006.
We grouped hospitals into quartiles based on their preregulation staffing levels and used a difference‐in‐difference approach to compare changes in staffing and in quality of care in alifornia hospitals to changes over the same time period in hospitals in 12 comparison states without minimum staffing legislation.
Data Collection/Extraction Methods
We merged data from the above data sources to obtain measures of nurse staffing and quality of care. We used gency for ealthcare esearch and uality's atient afety ndicators to measure quality.
With few exceptions, alifornia hospitals increased nurse staffing levels over time significantly more than did comparison state hospitals. Failure to rescue decreased significantly more in some alifornia hospitals, and infections due to medical care increased significantly more in some alifornia hospitals than in comparison state hospitals. There were no statistically significant changes in either respiratory failure or postoperative sepsis.
Following implementation of alifornia's minimum nurse staffing legislation, nurse staffing in alifornia increased significantly more than it did in comparison states' hospitals, but the extent of the increases depended upon preregulation staffing levels; there were mixed effects on quality.
