Is the Nurse Responsible for Resource Use in Home Health Care?

• Objective: To determine whether primary nurses contribute to variations in the use of home health resources. • Design: Observational study using review of billing records and fixed-effect least-squares regression analysis. • Setting and participants: All patients admitted to a large nursing agency over an 18-month period who had been hospitalized for cerebrovascular accident (CVA) or congestive heart failure (CHF). 566 patients were randomly assigned by geographic region to 255 primary nurses. • Measures: 6 measures of resource use were defined: length of stay, visits per week, timing of visits, registered nurse visits, labor costs, and skill level of visits. Fixed-effects least-squares regressions were estimated separately for each measure of resource use in both diagnoses, with the patient’s primary nurse as the fixed effect, controlling for patients’ severity of illness, age, and sex. • Results: In CVA patients, the primary nurse was a significant determinant (P ≥ 0.05) of the number of visits per week and the skill level of care provided during the visits for patients. In CHF patients, the primary nurse was a significant determinant of only registered nurse visits. • Conclusion: We found evidence that primary nurses differ in the pattern of care they provide for patients. The findings were stronger for patients with CVA than for patients with CHF. These findings suggest that nurses’ practice patterns play a role in determining home health resource use and that they can contribute to wide geographic variations in use of these resources.