Beyond Hospital-Level Aggregated Data: A Methodology to Adapt Clinical Data From the Electronic Health Record for Nursing Unit-Level Research.
Beyond Hospital-Level Aggregated Data: A Methodology to Adapt Clinical Data From the Electronic Health Record for Nursing Unit-Level Research.
复制标题
超越医院级汇总数据：一种将电子健康记录中的临床数据改编用于护理单位级研究的方法。
DOI：
10.1097/mlr.0000000000001972
复制
发表时间：
2024
期刊：
影响因子：
3
通讯作者：
Petersen,LauraA
中科院分区：
文献类型：
--
作者：
Yang,Christine;Kuebeler,MarkK;Jiang,Rebecca;Knox,MelissaK;Wong,JanineJ;Mehta,ParasD;Dorsey,LynetteE;Petersen,LauraA
背景：护士人员配置研究经常使用医院级汇总的数据，这些数据不能提供适当的背景来为单位级决策提供信息，例如护士人员配置。目的：描述一种方法，将在提供常规护理期间收集并记录在电子健康记录（EHR）中的患者数据与在国家数据集中进行护理的护理单位联系起来。研究设计：我们确定了2019年全国所有退伍军人健康管理局急性护理住院病例。我们使用人行横道将患者级别的电子病历和条形码药物管理数据与护理单位联系起来。我们根据患者的时间戳位置（病房停留时间）将住院时间划分为不同的时间段。我们计算了与护理单位相关的病房住院数和药物管理以及单位级和设施级平均患者风险评分。结果：我们提取了125个退伍军人健康管理机构的1117个护理单位、3782个EHR患者位置（与1,137,391个病房住院有关）和67,772个条形码药物管理位置（与147,686,996个药物管理有关）的数据。我们将89.46%的病房住院和93.10%的药物管理与护理单位联系起来。所有机构单位级别患者严重程度的平均（标准差）为4.71(1.52)，而机构级别为4.53（0.88）。结论：单位识别对于使用电子病历数据了解护理研究中单位层面的现象是必不可少的，并且可以为管理人员制定一线人员配置决策提供所需的具体信息。
Background:Studies of nurse staffing frequently use data aggregated at the hospital level that do not provide the appropriate context to inform unit-level decisions, such as nurse staffing.Objectives:Describe a method to link patient data collected during the provision of routine care and recorded in the electronic health record (EHR) to the nursing units where care occurred in a national dataset.Research Design:We identified all Veterans Health Administration acute care hospitalizations in the calendar year 2019 nationwide. We linked patient-level EHR and bar code medication administration data to nursing units using a crosswalk. We divided hospitalizations into segments based on the patient’s time-stamped location (ward stays). We calculated the number of ward stays and medication administrations linked to a nursing unit and the unit-level and facility-level mean patient risk scores.Results:We extracted data on 1117 nursing units, 3782 EHR patient locations associated with 1,137,391 ward stays, and 67,772 bar code medication administration locations associated with 147,686,996 medication administrations across 125 Veterans Health Administration facilities. We linked 89.46% of ward stays and 93.10% of medication administrations to a nursing unit. The average (standard deviation) unit-level patient severity across all facilities is 4.71 (1.52), versus 4.53 (0.88) at the facility level.Conclusions:Identification of units is indispensable for using EHR data to understand unit-level phenomena in nursing research and can provide the context-specific information needed by managers making frontline decisions about staffing.