Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia.
Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia.
复制标题
DOI：
10.1097/mlr.0b013e3182763284
复制
发表时间：
2013-01
期刊：
影响因子：
3
通讯作者：
Ma C
中科院分区：
文献类型：
--
作者：
McHugh MD;Ma C
《平价医疗法案》的规定增加了医院对可预防的再入院的财务责任，这提高了人们对确定系统级干预措施以减少再入院的兴趣。确定医院护理之间的关系；即护士工作环境、护士人员配置水平、护士教育以及患有心力衰竭、急性心肌梗死和肺炎的医疗保险患者的 30 天再入院情况。对加利福尼亚州、新泽西州和宾夕法尼亚州的关联数据进行分析，其中包括来自护士调查的医院护理组织信息（即工作环境、病人与护士的比例以及拥有 BSN 学位的护士比例），以及患者出院数据和美国医院协会年度调查数据。使用稳健逻辑回归来估计护理因素与 30 天再入院之间的关系。近四分之一的心力衰竭指数入院患者 (23.3% [n=39,954])； 19.1% (n=12,131) 因心肌梗塞入院； 17.8% (n=25,169) 的肺炎患者在 30 天内再次入院。护士平均工作量中每增加一名患者，心力衰竭患者再入院的几率就会增加 7%（OR=1.07，[1.05–1.09]），肺炎患者再入院几率增加 6%（OR=1.06，[1.03–1.09]），心肌梗死患者再入院几率增加 9%（OR=1.09，[1.05–1.13]）。工作环境良好的医院与工作环境差的医院相比，心力衰竭的再入院几率降低 7%（OR = 0.93，[0.89–0.97]）；心肌梗塞降低 6%（OR = 0.94，[0.88–0.98]）；肺炎患者则降低 10%（OR = 0.90，[0.85–0.96]）。改善护士的工作环境和人员配置可能是防止再入院的有效干预措施。
Provisions of the Affordable Care Act that increase hospitals’ financial accountability for preventable readmissions have heightened interest in identifying system-level interventions to reduce readmissions. To determine the relationship between hospital nursing; i.e. nurse work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Analysis of linked data from California, New Jersey, and Pennsylvania that included information on the organization of hospital nursing (i.e., work environment, patient-to-nurse ratios, and proportion of nurses holding a BSN degree) from a survey of nurses, as well as patient discharge data, and American Hospital Association Annual Survey data. Robust logistic regression was used to estimate the relationship between nursing factors and 30-day readmission. Nearly one-quarter of heart failure index admissions (23.3% [n=39,954]); 19.1% (n=12,131) of myocardial infarction admissions; and 17.8% (n=25,169) of pneumonia admissions were readmitted within 30-days. Each additional patient per nurse in the average nurse’s workload was associated with a 7% higher odds of readmission for heart failure (OR=1.07, [1.05–1.09]), 6% for pneumonia patients (OR=1.06, [1.03–1.09]), and 9% for myocardial infarction patients (OR=1.09, [1.05–1.13]). Care in a hospital with a good versus poor work environment was associated with odds of readmission that were 7% lower for heart failure (OR = 0.93, [0.89–0.97]); 6% lower for myocardial infarction (OR = 0.94, [0.88–0.98]); and 10% lower for pneumonia (OR = 0.90, [0.85–0.96]) patients. Improving nurses’ work environments and staffing may be effective interventions for preventing readmissions.