Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: These letters raise concerns about
the appropriateness of our analysis. Our article follows a long tradition
in health services research that asks whether differences in health care resources
are associated with variation in patient outcomes. Hospitals in which nurses
cared for fewer patients and in which a greater proportion of nurses had baccalaureate
degrees had lower rates of mortality and failure to rescue.
Using a sample of more than 232 000 patients in 168 hospitals,
we estimated the effects of nurse workload and educational mix simultaneously,
after controlling for more than 130 patient, hospital, and physician characteristics
including hospital size, teaching status, technology, and surgeon board certification.
Nurse education was significantly associated with patient outcomes after controlling
for these factors and for nurse workload and experience.
Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Relationship Between Patient Mortality and Nurses' Level of Education—Reply. JAMA. 2004;291(11):1320-1323. doi:10.1001/jama.291.11.1322-c