S PECIAL A RTICLE Health Care Professional Staffing, Hospital Characteristics, and Hospital Mortality Rates C. A. Bond, Pharm.D., FASHP, FCCP, Cynthia L. Raehl, Pharm.D., FASHP, Michael E. Pitterle, M.S., and Todd Franke, Ph.D. To evaluate associations among hospital characteristics, staffing levels of health care professionals, and mortality rates in 3763 United States hospitals, a data base was constructed from the American Hospital Association’s Abridged Guide to the Health Care Field and hospital Medicare mortality rates from the Health Care Financing Administration. A multivariate regression analysis controlling for severity of illness was employed to determine the associations. Hospital characteristics associated with lower mortality were occupancy rate and private nonprofit and private for-profit ownership. Mortality rates decreased as staffing level per occupied bed increased for medical residents, registered nurses, registered pharmacists, medical technologists, and total hospital personnel. Mortality rates increased as staffing level per occupied bed increased for hospital administrators and licensed practical-vocational nurses. To our knowledge, this is the first study to show that pharmacists were associated with lower mortality rates. (Pharmacotherapy 1999;19(2):130–138) Over the last 15 years substantial changes have occurred in the organizational structure and staffing patterns of many hospitals. 1–3 Reorganization (“downsizing,” “reengineering,” “right sizing”) has resulted in reduction of professional staff, consolidation of patient care units, and hospital mergers to produce lower costs. Few studies have evaluated the effects of staffing changes on quality of care or on specific outcome measures such as hospital mortality rates. Recent reports of deaths attributed to less well- trained and educated health care workers have attracted national media attention (e.g., ABC’s “Good Morning America,” September 30, 1996). In the 1996 general election, about 40% of California voters supported two ballot initiatives that would have established staffing levels for health professionals to ensure access and quality of care. 4 Texas recently enacted legislation to allow patients to sue health maintenance organizations that fail to approve or pay for health care treatments the patient believes are necessary. 5 Although public concern that the quality of health care has decreased secondary to cost cutting and staff reductions is growing, accurate measures and universally accepted standards of quality care remain elusive. 6, 7 Studies of hospital-based mortality rate were limited to exploring associations among demographic, teaching affiliation, ownership, staff education and training, disease, quality of care, and fiscal characteristics. 8–16 None of these From the Departments of Pharmacy Practice (Drs. Bond and Raehl) and Psychiatry (Dr. Bond), Schools of Pharmacy and Medicine, Texas Tech University Health Sciences Center–Amarillo, Amarillo, Texas; the Department of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin (Mr. Pitterle); and the Department of Biostatistics and Biometrics, School of Public Policy and Social Research, University of California at Los Angeles, Los Angles, California (Dr. Franke). Address reprint requests to C. A. Bond, Pharm.D., Department of Pharmacy Practice, Texas Tech University Health Sciences Center-Amarillo, 1300 South Coulter Street, Amarillo, TX 79106.