{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T09:17:39Z","timestamp":1758273459579},"reference-count":26,"publisher":"Wiley","issue":"7-8","license":[{"start":{"date-parts":[[2010,3,8]],"date-time":"2010-03-08T00:00:00Z","timestamp":1268006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2010,3,8]],"date-time":"2010-03-08T00:00:00Z","timestamp":1268006400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2010,3,8]],"date-time":"2010-03-08T00:00:00Z","timestamp":1268006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Belgian Ministry of Science Policy, in collaboration with the Belgian Ministry of Public Health","award":["AG\/01\/123"],"award-info":[{"award-number":["AG\/01\/123"]}]},{"name":"Interuniversity Attraction Poles Program P6\/03Belgian StateFederal Office for Scientific, Technical and Cultural Affairs"}],"content-domain":{"domain":["wiley.com"],"crossmark-restriction":true},"short-container-title":["Statistics in Medicine"],"published-print":{"date-parts":[[2010,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Studies based on aggregated hospital outcome data have established that there is a relationship between nurse staffing and adverse events. However, this result could not be confirmed in Belgium where 96 per cent of the variability of nurse staffing levels over nursing units (belonging to different hospitals) is explained by within\u2010hospital variability. To better appreciate the possible impact of nurse staffing levels on adverse events, we propose a multilevel approach reflecting the complex nature of the data. In particular we suggest a clustered discrete\u2010time logistic model that captures the risks associated with a given unit in the patient's trajectory through the hospital. The model also allows for nurse staffing levels to affect the current and subsequent nursing unit (carry\u2010over effect). In the model \u2018time\u2019 is represented by the sequential number of the nursing unit that the patient is passing through. The model incorporates hospital and nursing unit random effects to express that patients treated in the same hospital and taken care of by nurses of the same unit share a common environment. In this study we used Belgian national administrative databases for the year 2003 to assess the relationship between nurse staffing levels and nurse education variables with in\u2010hospital mortality. The analysis was restricted to elective cardiac surgery patients. Lower nursing unit staffing levels in the general nursing units were associated with high in\u2010hospital mortality in units past the traditional cardiac surgery nursing units. Copyright \u00a9 2010 John Wiley &amp; Sons, Ltd.<\/jats:p>","DOI":"10.1002\/sim.3756","type":"journal-article","created":{"date-parts":[[2010,3,8]],"date-time":"2010-03-08T09:59:36Z","timestamp":1268042376000},"page":"778-785","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Establishing the relationship between nurse staffing and hospital mortality using a clustered discrete\u2010time logistic model"],"prefix":"10.1002","volume":"29","author":[{"given":"L.","family":"Diya","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Lesaffre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Van den Heede","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W.","family":"Sermeus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Vleugels","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2010,3,8]]},"reference":[{"key":"e_1_2_1_2_2","volume-title":"To Err is Human: Building a Safer Health System","author":"Kohn LT","year":"1999"},{"key":"e_1_2_1_3_2","unstructured":"Agency for Health Research and Quality. AHRQ's patient safety initiative: building foundations reducing risk. Interim Report to the Senate Committee on Appropriations. AHQR Publication No. 04\u2010Rg005 2004. Available from:http:\/\/www.ahrq.gov\/qual\/pscongrpt\/."},{"key":"e_1_2_1_4_2","volume-title":"Risk Adjustment for Measuring Health Care Outcomes","author":"Iezzoni LI","year":"2003"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/qhc.11.1.104"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1995.tb124691.x"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1040498"},{"key":"e_1_2_1_8_2","volume-title":"Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?","author":"Wunderlich G","year":"1996"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.16.1987"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.290.12.1617"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2007.05.006"},{"key":"e_1_2_1_12_2","unstructured":"van Den HeedeK.Nurse\u2010staffing levels and patient safety in acute hospitals: analyzing administrative data at the nursing unit level. Ph.D. in Medical Sciences Centre for Health Services and Nursing Research Department of Public Health Katholieke Universiteit Leuven Centre for Health Services and Nursing Research Kapucijnenvoer Leuven Belgium 2008. ISBN 9729961506."},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200008000-00004"},{"key":"e_1_2_1_14_2","unstructured":"AverilRF GoldfieldN HughesJS BonazelliJ McCulloughEC SteinbeckBA MullinR TangAM.Development of the all patient refined DRGs (APR\u2010DRGs). 3 M HIS Research Report. 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