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March 17, 2004

Relationship Between Patient Mortality and Nurses' Level of Education

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(11):1320-1323. doi:10.1001/jama.291.11.1322-a

To the Editor: Dr Aiken and colleagues1 discounted the effect of surgeons' qualifications and overall hospital quality on patient mortality. The authors stated that "the strong and significant decrease in mortality associated with having a board-certified surgeon as operating physician is largely explained by the tendency of patients with board-certified surgeons to be treated at hospitals with other characteristics associated with better outcomes." Although hospitals with more board-certified surgeons also had more nurses with baccalaureate degrees, the authors did not examine these "other characteristics" to explain the much smaller difference in patient mortality associated with nurses' educational background.

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