Valuing hospital investments in nursing: multistate matched-cohort study of surgical patients.
Valuing hospital investments in nursing: multistate matched-cohort study of surgical patients.
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DOI：
10.1136/bmjqs-2019-010534
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发表时间：
2021-01
影响因子：
5.4
通讯作者：
Silber JH
中科院分区：
文献类型：
--
作者：
Lasater KB;McHugh M;Rosenbaum PR;Aiken LH;Smith H;Reiter JG;Niknam BA;Hill AS;Hochman LL;Jain S;Silber JH
在护理方面的投资有一些已知的临床益处。人们对它们的价值知之甚少。比较护理资源较好的医院和护理资源较差的医院的手术患者结果和费用，并确定这些医院对不同死亡风险的患者的价值是否不同。回顾性匹配队列设计：患者与护士比例、技能组合、学士学位护士比例和护士工作环境定义了护理资源较好与较差医院的患者结局。样本包括2013 - 2015年76家护理资源较好的医院和230家护理资源较差的医院的62 715对手术患者。患者在主要手术、医院规模类别、教学和技术状况上完全匹配，在合并症和其他危险因素上紧密匹配。护理资源较好的医院的患者30天死亡率较低：2.7%对3.1% (p<0.001)，抢救失败率较低：5.4%对6.2% (p<0.001)，再入院率较低：12.6%对13.5% (p<0.001)，住院时间较短：4.70天对4.76天（p<0.001），更多的重症监护病房入院率：17.2%对15.4% (p<0.001)，护士调整成本略高（这是更好的护理资源的成本）。与护理资源较差的医院的患者相比，20 096美元vs 19 358美元（p<0.001）。在护理较好的医院，死亡率每提高1%，护士调整后的成本为2035美元。死亡风险最高的患者实现了护理资源的最大价值。拥有更好护理资源的医院以少量额外费用为外科病人提供了更好的临床结果。一般来说，病人病情越重，护理资源越好的医院的价值就越大。
There are known clinical benefits associated with investments in nursing. Less is known about their value. To compare surgical patient outcomes and costs in hospitals with better versus worse nursing resources and to determine if value differs across these hospitals for patients with different mortality risks. Retrospective matched-cohort design of patient outcomes at hospitals with better versus worse nursing resources, defined by patient-to-nurse ratios, skill mix, proportions of bachelors-degree nurses and nurse work environments. The sample included 62 715 pairs of surgical patients in 76 better nursing resourced hospitals and 230 worse nursing resourced hospitals from 2013 to 2015. Patients were exactly matched on principal procedures and their hospital’s size category, teaching and technology status, and were closely matched on comorbidities and other risk factors. Patients in hospitals with better nursing resources had lower 30-day mortality: 2.7% vs 3.1% (p<0.001), lower failure-to-rescue: 5.4% vs 6.2% (p<0.001), lower readmissions: 12.6% vs 13.5% (p<0.001), shorter lengths of stay: 4.70 days vs 4.76 days (p<0.001), more intensive care unit admissions: 17.2% vs 15.4% (p<0.001) and marginally higher nurse-adjusted costs (which account for the costs of better nursing resources): $20 096 vs $19 358 (p<0.001), as compared with patients in worse nursing resourced hospitals. The nurse-adjusted cost associated with a 1% improvement in mortality at better nursing hospitals was $2035. Patients with the highest mortality risk realised the greatest value from nursing resources. Hospitals with better nursing resources provided better clinical outcomes for surgical patients at a small additional cost. Generally, the sicker the patient, the greater the value at better nursing resourced hospitals.
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影响因子：
168.9
作者：
Aiken, Linda H.;Sloane, Douglas M.;Bruyneel, Luk;Van den Heede, Koen;Griffiths, Peter;Busse, Reinhard;Diomidous, Marianna;Kinnunen, Juha;Kozka, Maria;Lesaffre, Emmanuel;McHugh, Matthew D.;Moreno-Casbas, M. T.;Rafferty, Anne Marie;Schwendimann, Rene;Scott, P. Anne;Tishelman, Carol;van Achterberg, Theo;Sermeus, Walter
通讯作者：
Sermeus, Walter
影响因子：
3
作者：
Kutney-Lee A;Stimpfel AW;Sloane DM;Cimiotti JP;Quinn LW;Aiken LH
通讯作者：
Aiken LH
影响因子：
3
作者：
Dall, Timothy M.;Chen, Yaozhu J.;Hogan, Paul F.
通讯作者：
Hogan, Paul F.
影响因子：
3
作者：
Martsolf, Grant R.;Auerbach, David;Gibson, Teresa B.
通讯作者：
Gibson, Teresa B.
影响因子：
120.7
作者：
Aiken, LH;Clarke, SP;Silber, JH
通讯作者：
Silber, JH