Author Affiliations: Assistant Director for Advanced Practice Nursing (Dr Kapu), Vanderbilt University Hospital, and Assistant in Division of Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee; Director (Dr Kleinpell), Center for Clinical Research and Scholarship, Rush University Medical Center, and Professor, College of Nursing, Rush University, Chicago, Illinois; Professor, Health Systems Management (Dr Pilon), and Senior Associate Dean, Clinical and Community Partnerships, School of Nursing, Vanderbilt University,Nashville, Tennessee.
J Nurs Adm. 2014 Feb;44(2):87-96. doi: 10.1097/NNA.0000000000000031.
The purpose of this project was to examine the financial impact of adding nurse practitioners (NPs) to inpatient care teams at Vanderbilt University Hospital.
National initiatives targeting quality, safe, and cost-effective healthcare have created the optimal environment for NPs to showcase their abilities and contributions. Identifying outcomes that are directly affected by NPs and quantifying data in terms of dollars can be affirmation for the contribution of the NP practice. Value can be garnered in terms of revenue generation and cost-effectiveness of hiring NP providers; however, a considerable financial impact can be in cost avoidance and cost savings through NP-associated outcomes of care.
This was a retrospective, secondary analysis of return on investment after adding NPs to 5 teams. Software was used to abstract billing, acuity, and length of stay (LOS) data and NP-associated quality metrics. Billing data, LOS, and risk-adjusted LOS data for designated years before and after adding NPs were compared.
Gross collections compared with expenses for 4 NP-led teams for 2 year time periods were 62%, 36%, and 47%, and +32%. Average risk-adjusted LOS for the 5 time periods after adding NPs decreased and charges decreased, thus demonstrating less resource use. Most clinical outcomes improved beyond preproject baselines.
This project demonstrated the value of adding NPs to inpatient care teams by means of generated revenue, reduction in LOS, and standardization of quality care.
本项目旨在研究范德比尔特大学医院将护士从业者 (NP) 添加到住院护理团队中对财务的影响。
以质量、安全和具有成本效益的医疗保健为目标的国家举措为 NP 展示其能力和贡献创造了最佳环境。确定直接受 NP 影响的结果，并以货币形式量化数据，可以证明 NP 实践的贡献。可以通过雇用 NP 提供者的收入产生和成本效益来获得价值；但是，通过 NP 相关的护理结果，可以避免和节省成本，从而产生可观的财务影响。
这是对添加 5 个团队的 NP 后投资回报的回顾性二次分析。使用软件提取计费、疾病严重程度和住院时间 (LOS) 数据以及 NP 相关的质量指标。比较指定年份添加 NP 前后的计费数据、LOS 和风险调整后的 LOS 数据。
4 个 NP 领导的团队在 2 年时间内的总收入与支出之比为 62%、36%和 47%，增加了 32%。添加 NP 后 5 个时间段的平均风险调整后的 LOS 降低，收费减少，从而表明资源使用减少。大多数临床结果都超过了项目前的基线。
本项目通过产生的收入、缩短 LOS 和标准化高质量护理，证明了将 NP 添加到住院护理团队中的价值。
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