Nursing Workforce Impact on Rural Hospital Performance Improvement in the Hospital Quality Incentive Demonstration Project

Research center:
Lead researcher:
Project funded:
September 2007
Project completed:
May 2010
The CMS/premier Hospital Quality Incentive Demonstration (HQID) was the first national demonstration designed to test the effectiveness of financial incentives for improving the quality of care provided to Medicare beneficiaries. The initial results from the HQID project reported quality performance improvement across all clinical conditions, but there is limited understanding of the relative contributions of factors such as nurse staffing to performance improvement.

The purpose of this project is to examine the impact of nurse staffing on hospital performance improvement in the HQID project with specific interest in whether and how this relationship differs in rural hospitals as compared to urban hospitals.

Performance improvement will be measured using composite scores for three conditions: acute myocardial infarction, pneumonia, and heart failure. To examine the relationship between nurse staffing and patient outcomes, we will empirically assess a number of specifications that include hours of nursing care and the mix of skills of the nursing personnel. We will assess the degree of heterogeneity in any improvement in quality and whether that heterogeneity can be explained by the level and mix of nursing inputs, using multilevel models.

The products of this project will include a working paper, a policy brief, and an article that will be submitted to a peer-reviewed journal.


  • Nurse Staffing and Rural Hospital Performance
    Policy Brief
    Upper Midwest Rural Health Research Center
    Date: 12/2010
    This policy brief examines the impact of nurse staffing on rural hospital performance improvement in the CMS/Premier Inc. Hospital Quality Incentive Demonstration project.