Staffing intensity, skill mix and mortality outcomes: the case of chronic obstructive lung disease

Health Serv Manage Res. 1999 Nov;12(4):258-68. doi: 10.1177/095148489901200407.


The hospital re-engineering movement has resulted in major changes in hospital staffing. These staffing changes have the potential to reduce staffing intensity and skill mix, both generally and within specific caregiver groups. Prior research has shown that both skill mix and staffing intensity are positively associated with outcomes indicative of the quality of hospital care. This study extends beyond prior research by expanding the scope of staffing intensity and skill mix measures beyond that of physicians and nursing personnel and by focusing on a specific diagnostic group, patients with chronic obstructive pulmonary disease (COPD). Multiple regression analysis was performed using the 30-day post-admission observed mortality rate for Medicare patients being treated for COPD relative to the predicted rate as the dependent variable. Analyses were repeated for 1989, 1990 and 1991. Among the explanatory variables were staffing intensity measures for health care workers that were thought to contribute significantly to the care needed by patients with COPD. The results indicate that the only group of health care workers which showed staffing intensities positively associated with better outcomes in this group of patients was respiratory care practitioners, respiratory therapists and respiratory therapy technicians. The results relative to skill mix were inconclusive. It was concluded that during the 1989-1991 period, hospitals with higher staffing intensities for both respiratory therapists and respiratory therapy technicians had better outcomes for their Medicare inpatients being treated for COPD.

MeSH terms

  • American Hospital Association
  • Centers for Medicare and Medicaid Services, U.S.
  • Chronic Disease
  • Clinical Competence*
  • Health Services Research / methods
  • Hospital Mortality*
  • Hospital Restructuring* / standards
  • Humans
  • Lung Diseases, Obstructive / mortality*
  • Lung Diseases, Obstructive / therapy*
  • Multivariate Analysis
  • Organizational Case Studies
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Personnel Downsizing
  • Personnel Staffing and Scheduling*
  • Personnel, Hospital / supply & distribution*
  • Quality of Health Care
  • Regression Analysis
  • United States / epidemiology
  • Workforce