Estimating the effect of New Jersey’s 2005 administrative nurse mandate on mortality and hospitalizations for medicare hemodialysis patients

Abstract

Background and objectives In 2005, the New Jersey Department of Health enacted a rule requiring that an administrator or designate always be present in a hemodialysis clinic and that the individual may not be involved in patient care activities at any time. Our investigation examines the effect of this unique rule on patient mortality and hospitalizations and is meant to inform the public policy discussion. Design, setting, participants, and measurements We utilized a synthetic control estimation to analyze the effect of this rule on patient mortality in New Jersey. We also compared trends for hospitalizations in New Jersey to other similar states. Results We find no evidence that the law affected patient mortality or the number of hospitalizations for Medicare patients in New Jersey. Conclusions The New Jersey law poses substantial costs to hemodialysis clinics and we find little evidence of any measurable benefit to patients.

Estimating the effect of dialysis staffing ratio regulations on mortality and hospitalizations for Medicare hemodialysis patients

“…Despite these potential issues, some past work has relied on state-level outcomes. 7,11 Furthermore, work using facility-level measures of quality do find strong effects of minimum staffing ratios, which we believe should be measurable at the state level. Due to data limitations, we were also unable to examine other measures of quality, like staff burnout, medical errors, bloodborne infections, and patient satisfaction.…”

“…Historical facility‐level survey data in each state would be necessary to determine whether the lack of effect is driven by previously high staff to patient ratios. Despite these potential issues, some past work has relied on state‐level outcomes 7,11 . Furthermore, work using facility‐level measures of quality do find strong effects of minimum staffing ratios, which we believe should be measurable at the state level.…”

“…In related work, a unique regulation in New Jersey requiring each hemodialysis facility employ a nurse administrator was found to have no impact on quality. 11 In this study, we estimated the impact of dialysis facility minimum staffing ratio regulations on patient health outcomes. Minimum staffing ratios are designed to improve patient outcomes.…”

“…However, their initial study does not control for state or patient characteristics and relies on a cross section of data. In related work, a unique regulation in New Jersey requiring each hemodialysis facility employ a nurse administrator was found to have no impact on quality 11 …”