Minnesota Department of Health Question & Answer Sheet
July 22, 2014
MDH Nurse Study Data Collection
Data Collection Template and Instructions are located at:
http://www.health.state.mn.us/divs/hpsc/hep/nursestudy/
Background
During the 2013 Regular Session, the
Minnesota Legislature passed Minnesota
Law Chapter 51—HF588 directing the
Department of Health (MDH) to conduct a
study of the correlation between nurse
staffing levels and patient outcomes at
Minnesota hospitals.
The study language was part of a broader
bill, titled Staffing Plan Disclosure Act,
which requires the development of a system
through which hospitals would disclose
planned and actual nurse staffing levels on a
quarterly basis starting in 2014.
To assist in planning for this study, MDH
convened a workgroup to advise on issues
related to data availability, nurse-sensitive
indicators, and methodological decisions.
Workgroup members and materials are
available online: www.health.state.mn.us/
divs/hpsc/hep/nursestudy/
Questions and Answers
Q: Why are hospitals requested to report
nurse staffing data in addition to the data
submitted to the Minnesota Hospital
Association (MHA) as part of the Staffing
Plan Disclosure Act?
A: Existing data have a number of
limitations that would impede conducting a
robust study:
 Data submitted as part of the Staffing
Plan Disclosure Act (SPDA) are highly
aggregated; for each unit, there is a
single staffing measure for each quarter
that represents average staffing levels for
that quarter. Quarterly data prevents
detecting any potential variation in
staffing volume.
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As many members of the workgroup
reiterated, information about staffing
mix (RN/LPN) is essential for
understanding differences in both
staffing levels and outcomes. Data
reported by hospitals under the SPDA
only identifies registered nurses and
other assistive personnel;
Existing staffing data does not overlap
chronologically with patient outcomes
data. This means that data for case-mix
adjustment would also not be available,
and drawing any inferences between
staffing and outcomes from different
periods would be largely impossible; and
The existing data are limited to a threemonth period, which eliminates the use
of a number of outcome measures
because of limited number of cases.
Q: How is MDH planning to use daily nurse
staffing data?
A: To truly study the relationship between
nurse staffing and patient outcomes, most
robust studies use information at the unitand shift-level, and if possible, at the
individual patient-level. MDH is requesting
daily nurse staff hours and patient census for
a 12 month period so that outcomes,
including measures such as length of
hospital stays, at aggregated unit-levels can
be statistically associated with nurse staffing
levels. The primary unit of analysis will be
a grouping of care units.
Q: Isn’t staffing data generally available
just for the overall hospital? How will unit
and date-specific staffing data help MDH in
conducting the study?
A: Most of the nurse-sensitive outcome
measures available for this study
(www.health.state.mn.us/divs/hpsc/hep/nurs
MDH Nurse Study Data Collection -- Questions & Answers
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July 22, 2014
estudy/nursesensitiveoutcomemeasure.pdf)
are so called claims-based measures. MDH
will calculate these measures based on 2013
claims in Minnesota’s hospital
administrative discharge data set.
Q: Don’t patient outcomes data (hospital
administrative discharge data) span multiple
unit types and shifts, creating a problem in
matching a patient with nurse staffing on
specific units?
A: The use of administrative discharge data
is quite common in the study of patient
outcomes. Because administrative data sets
do not typically include fixed dates when
patients are at specific care units, MDH will
be using procedure specific information in
revenue codes to inform the analysis.
Q: Has the grouping of patients into unit
categories been done before in other
research?
A: The categorization of patients by unit
type, such as intensive care units, has been
validated by the US Agency for Healthcare
Research & Quality (AHRQ).1 Another
approach implemented in a recent published
peer-reviewed article on nurse staffing and
patient outcomes segmented general
medical-surgical hospital claims from claims
likely to be seen in other departments such
as critical care by diagnosis related group
flags alone.2
Q: Why aren’t individual hospital unit shifts
being analyzed?
A: Shift-level analysis is not possible using
existing hospital administrative discharge
data because they lack time stamps that
correspond to shifts. Shift-level nurse
staffing data is not being requested from
hospitals.
Q: Why isn’t MDH using electronic medical
record (EMR) data that may have shift-level
information to conduct analysis?
A: EMR data could be a potential data
source for studies such as the one required
by the Minnesota Legislature. At this point,
however, use of these systems for nurse
staffing and monitoring patient
characteristics lacks the needed uniformity.
Q: Why are only certain Minnesota
hospitals providing nurse staffing data?
A: In the literature concerning the study of
nurse staffing and patient outcomes,
hospitals with an average daily census of
less than 20 or an occupancy rate below 20
percent, as well as facilities with extremely
high or low levels of staffing per patient day
are generally excluded.3 For this study,
MDH is requesting data from facilities with
sufficient number of cases for relevant
outcome measures, or about 40 hospitals.
Q: How will MDH protect the nurse staffing
data?
A: MDH is collecting the information under
its statutory authority in Minn. Stat. 62J.301
to 62J.42. This statute maintains the data
classifications established by the data
practices act, with some exceptions. Under
this act, data on institutions, unless
otherwise defined, is considered non-public.
Data requested by MDH from hospitals for
this study will be non-public data.
To reduce the potential burden associated
with producing the data, MDH permits
hospitals to submit de-identified nurse-level
data. Such data would be considered private
data on individuals. In each case, MDH will
apply rigorous safeguards to the data ,
beginning with the secure submission of
data, and will comply with all requirements
MDH Nurse Study Data Collection Question & Answer Sheet
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July 22, 2014
of the Minnesota Government Data
Practices Act.
References
1
Elixhauser A, Barrett M, Nisbet J. Development of
Utilization Flags for Use with UB-92 Administrative
Data. HCUP Methods Series Report # 2006-04
Online. July 14, 2006. U.S. Agency for Healthcare
Research and Quality. Available at:
http://www.hcup-us.ahrq.gov/reports/methods.jsp
2
Cook A, M Gaynor, M Stephens Jr., and L Taylor.
(2012). The Effect of a Hospital Nurse Staffing
Mandate on Patient Health Outcomes: Evidence from
California’s Minimum Staffing Regulation. Journal
of Health Economics, 31:340-348.
3
See for example, Needleman J, et al. (2002). NurseStaffing Levels and the Quality of Care in Hospitals
New England Journal of Medicine; 346(22):1715-22.