LOWER MEDICARE MORTALITY AMONG A SET OF HOSPITALS KNOWN FOR GOOD NURSING-CARE

The objective of this study is to investigate whether hospitals known to be good places to practice nursing have lower Medicare mortality th an hospitals that are otherwise similar with respect to a variety of n on-nursing organizational characteristics. Research to date on determi nants of hospital mortality has not focused on the organization of nur sing. We capitalize on the existence of a set of studies of 39 hospita ls that, for reasons other than patient outcomes, have been singled ou t as hospitals known for good nursing care. We match these ''magnet'' hospitals with 195 control hospitals, selected from all nonmagnet U.S. hospitals with over 100 Medicare discharges, using a multivariate mat ched sampling procedure that controls for hospital characteristics. Me dicare mortality rates of magnet versus control hospitals are compared using variance components models, which pool information on the five matches per magnet hospital, and adjust for differences in patient com position as measured by predicted mortality. The magnet hospitals' obs erved mortality rates are 7.7% lower (9 fewer deaths per 1,000 Medicar e discharges) than the matched control hospitals (P = .011). After adj usting for differences in predicted mortality, the magnet hospitals ha ve a 4.6% lower mortality rate (P =.026 [95% confidence interval 0.9 t o 9.4 fewer deaths per 1,000]). The same factors that lead hospitals t o be identified as effective from the standpoint of the organization o f nursing care are associated with lower mortality among Medicare pati ents.