Egor Buharin has had a busy summer as a SUMR scholar mentored by Matthew D McHugh. He has worked on multiple research projects including analyzing end-of-life care costs and trends, California's nurse-to-patient mandate, and conducting nurse and patient surveys across 30 hospitals in the United Arab Emirates. Through these experiences, he has gained valuable skills in statistical programming, learned the challenges of organizing large datasets, and seen the potential impact of using empirical data to inform healthcare policy decisions internationally.

1. My Busy SUMR
By Egor Buharin
Mentored by Matthew D McHugh, PhD, JD, MPH, RN, CRNP

2. Interesting Situation
∗ Continuation of former research and new projects
∗ October, 2010 – Center for Health Outcomes and
Policy Research (CHOPR)
∗ Flurry of projects

3. Visual Diagrams – Impact of Nurse
Residency Programs

4. Visual Representation of research

5. Diagrams

6. Projects
∗ End-of-Life Care: statistical programming
∗ California’s Nurse-to-Patient Mandate
∗ United Arab Emirates – several thousand nurse and
patient surveys.

7. End of Life
∗ Set the scene.
∗ 2,423,995 people died in the U.S. Of these, estimated that 765,651 died in the
hospital – 32 percent (2007)
∗ Among the elderly, 31 percent of deaths occurred in the hospital
∗ Approximately 75% of 65+ people have at least one chronic condition
∗ Chronically ill patients often spend their last days in a hospital – society
∗ 50 percent of the conscious patients who die in the hospital have moderate-to-
severe pain at least half the time. – New England Journal of Medicine
∗ Passive euthanasia – legal
∗ Hospice
• The Costs of End-of-Life Hospitalizations, 2007 - Yafu Zhao, M.S. and William Encinosa, Ph.D
• AHRQ - Preventing Disability in the Elderly With Chronic Disease

9. +50,000,000 observation

10. Dartmouth – End of Life Trend
Report
44 page report: Dartmouth Institute for
Health Policy and Clinical Practice
∗ 67 to 99 years
∗ full Part A and Part B entitlement throughout the last two years
of life
∗ Persons enrolled in managed care organizations were excluded
from the analysis.
∗ Patients with surgical admissions only were excluded (a patient
∗ whose only hospital admission was for bypass surgery could only
be assigned to
∗ the hospital where the surgery was performed)
∗ based on the first qualifying
∗ ICD-9-CM diagnosis code encountered on the claim closest to
death

11. Experience
My Struggles My Supports
∗ I don’t know what I
don’t know ∗ Medicare Data
∗ Learning STATA ∗ Researchers’
∗ Learning SAS assistance
∗ Identify all readmissions
associated with the ∗ Resources (forums
patients that passed and textbooks)
during the years of
collected data
∗ Combine patient data
with hospital data

12. Lessons Learned / Experience Gained
∗ Beauty of tutorials
∗ Frustration of poor organization / lack of
standardization
∗ Importance of efficiency
∗ Value of programmer comments

13. Background: California’s Nurse
Mandate
 Claims that a lower patient-to-nurse ratio promotes better
patient outcomes
 1999 – Legislation signed into law
 2002 – Final ratios hospitals would face are released
 2004 – Mandate implemented

14. California’s Nurse to Patient Mandate
∗ Linda H. Aiken, PhD, RN; Sean P. Clarke, PhD, RN; Douglas M.
Sloane…
∗ Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and
Job Dissatisfaction
∗ each additional patient per nurse was associated with a 7% increase in the
likelihood of dying within 30 days of admission
∗ 7% increase in the odds of failure-to-rescue.
∗ 23% increase in the odds of burnout and a 15% increase in the odds of job
dissatisfaction.
Policy

15. Propelled Research: 2056
∗ Magnet Hospitals
∗ Hospital or department closings (not significant)
∗ Public reporting: Nurse to Patient Ratios – increased
competitiveness among hospitals
∗ Lower percentage of skilled nurses (BSN trained): paper

16. California’s Nurse-to-Patient
Mandate
∗ California hospitals on average followed
the trend of hospitals nationally by increasing their
nursing skill mix, and they primarily used more highly skilled registered
nurses to meet the staffing mandate
∗ staffing mandate resulted in roughly an
additional half-hour of nursing per adjusted
patient day beyond what would have been expected
in the absence of the policy
∗ Lower Medicare Mortality Among a Set of Hospitals
Known for Good Nursing Care – Magnet Hospital
have 9.4 fewer deaths per 1000 patients
∗ My part; literary reviews

17. Tremendous Gain
∗ Inside the head of a researcher
∗ Discuss inherent problems
∗ Search for solutions
∗ Be part of the developmental processes

18. United Arab Emirates
∗ Established as a country in 1973
∗ 30% of world’s cranes in Dubai – 2008
∗ The UAE is classified as a high-income developing economy by
the International Monetary Fund.
∗ A high per-capita nominal GDP of US$47,407 for the last fiscal
year.

19. Dubai
∗ Monday, May 10th, 2010
∗ Dr. Lauren Arnold - consultant to the
UAE Ministry of Health and Executive
Director of the newly formed UAE
Council on Nursing
∗ Operates out of the Office of Her
Royal Highness Princess Haya

20. ∗ Ghada Sherry. Ghada is Head of practice Development Section,
Federal Department of Nursing, Ministry of Health
∗ Deputy Minister
∗ Dr. Fatima Rafai, Chief Nurse of UAE
∗ Dr. Linda Aiken
∗ Dr. Hanif Al Qassimi, Minister of Health for United Arab Emirates
∗ Dr. Lauren Arnold

21. The Surveys
∗ 30 general hospitals of over 100 beds in the UAE
∗ EU research protocol surveying nurses and patients
∗ Grant from Emirates Foundation and the Ministry
∗ Nursing survey - 8 pages, 15 questions each.

22. Intent
∗ Use empirical data to sculpt a modern healthcare
system
∗ Very malleable – as oppose to the healthcare system
of the United States
∗ Create a international model

23. Coding
∗ First – skim through packets searching for excessive
mistakes.
∗ Interesting findings from first glance: Nurses were
eager to vent.
∗ Physical and verbal abuse from patients, patients’
families, and superiors – Very Dissatisfied

24. Technical Lessons
∗ Properly construct survey
∗ Typos
∗ Leave no room to wiggle
∗ BASIC
∗ Importance of automated coding
∗ Countless work-hours
∗ Time consuming labor

25. Appreciation
∗ Matthew D McHugh, PhD, JD, MPH, RN, CRNP
∗ All personnel and faculty that make SUMR possible
∗ SUMR Scholars