Medical Care:
doi: 10.1097/MLR.0b013e3182726cc5
Original Articles
Lower Mortality in Magnet Hospitals
McHugh, Matthew D. PhD, JD, MPH, RN*; Kelly, Lesly A. PhD,
RN†; Smith, Herbert L. PhD‡; Wu, Evan S. BA§;
Vanak, Jill M. MSN, RN§; Aiken, Linda H. PhD, RN§
Supplemental Author Material
Abstract
Background: Although there is evidence that hospitals recognized for
nursing excellence—Magnet hospitals—are successful in attracting and retaining
nurses, it is uncertain whether Magnet recognition is associated with better
patient outcomes than non-Magnets, and if so why.
Objectives: To determine whether Magnet hospitals have lower
risk-adjusted mortality and failure-to-rescue compared with non-Magnet
hospitals, and to determine the most likely explanations.
Method and Study Design: Analysis of linked patient, nurse, and
hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression
models were used to estimate differences in the odds of mortality and
failure-to-rescue for surgical patients treated in Magnet versus non-Magnet
hospitals, and to determine the extent to which differences in outcomes can be
explained by nursing after accounting for patient and hospital differences.
Results: Magnet hospitals had significantly better work environments
and higher proportions of nurses with bachelor’s degrees and specialty
certification. These nursing factors explained much of the Magnet hospital
effect on patient outcomes. However, patients treated in Magnet hospitals had
14% lower odds of mortality (odds ratio 0.86; 95% confidence interval,
0.76–0.98; P=0.02) and 12% lower odds of failure-to-rescue (odds ratio
0.88; 95% confidence interval, 0.77–1.01; P=0.07) while controlling for
nursing factors as well as hospital and patient differences.
Conclusions: The lower mortality we find in Magnet hospitals is
largely attributable to measured nursing characteristics but there is a
mortality advantage above and beyond what we could measure. Magnet recognition
identifies existing quality and stimulates further positive organizational
behavior that improves patient outcomes.
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