RNs Required Under Proposed Federal Standards per 1,000 Decedents, by Interval Before Death
(Interval Before Death: Last Two Years of Life; Year: 2014)
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    • YEAR:
    • Interval Before Death:
    • Region Type:

      • FOOTNOTES:
      • Our estimate is based on proposed federal staffing requirements set out in legislation considered by Congress (“Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007” H.R. 2123). The bill sets out minimum staffing requirements based on the ratio of patients in hospital to the number of FTE registered nurses. The requirements differ according to the intensity of the care setting. For high-intensity ICUs and cardiac care units (CCUs), the standard is no more than two patients for every nurse; for “step-down,” or intermediate ICUs, the standard is no more than three patients per nurse; and for medical and surgical units, the minimum standard is four patients per registered nurse. The rate was calculated by multiplying high-intensity ICU bed inputs by 1.5 (3 eight-hour shifts ÷ 2 patients per nurse), intermediate-intensity ICU bed inputs by 1 (3 eight -hour shifts ÷ 3 patients per nurse), and medical and surgical bed inputs by .75 (3 eight -hour shifts ÷ 4 patients per nurse). The results were then added together.

      • Click here to read about changes in methods between the 2001-05 and 2003-07 analyses. The study population includes beneficiaries with one of nine chronic conditions who were enrolled in traditional (fee-for-service) Medicare and died during the measurement period. To allow for two years of follow-back for all patients, the population is restricted to those whose age on the date of death was 67 to 99 years, and to those having full Part A and Part B entitlement throughout the last two years of life. Persons enrolled in managed care organizations were excluded from the analysis. For the hospital-specific analyses, patients had to be hospitalized for chronic illness at least once during their last two years of life to be included. For regional analyses, all patients diagnosed with a chronic illness were included.

      • Rates are adjusted for age, sex, race, primary chronic condition, and the presence of more than one chronic condition using ordinary least squares regression.


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The Dartmouth Atlas of Health Care is based at The Dartmouth Institute for Health Policy and Clinical Practice and is supported by a coalition of funders led by the Robert Wood Johnson Foundation, including the WellPoint Foundation, the United Health Foundation, the California HealthCare Foundation, and the Charles H. Hood Foundation.