Examining the Value of Inpatient Nurse Staffing An Assessment of Quality and Patient Care Costs
Examining the Value of Inpatient Nurse Staffing An Assessment of Quality and Patient Care Costs
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DOI：
10.1097/mlr.0000000000000248
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发表时间：
2014-11-01
期刊：
影响因子：
3
通讯作者：
Gibson, Teresa B.
中科院分区：
文献类型：
--
作者：
Martsolf, Grant R.;Auerbach, David;Gibson, Teresa B.
背景：住院病人质量缺陷对病人的健康和幸福有重要影响。它们还通过导致更长的住院时间和更高的治疗强度，对支付者和医院产生重要的财务影响。许多这些昂贵的质量缺陷是特别敏感的护理care.Objective：评估护理质量和住院护理costs.Design的护士人员配置的效果：纵向分析使用医院护士人员配置数据和医疗保健成本和利用项目状态住院患者数据库从2008年到2011年。加州、内华达州和马里兰州的出院人数（n = 18，474，860）。一个纵向的医院固定效应模型被用来评估护理人员配备水平和技能组合对患者护理费用、住院时间和不良事件的影响，调整患者的临床和人口统计学特征。结果：增加护士的人员配备水平与减少护理敏感的不良事件和住院时间，但并没有导致增加病人的护理费用。通过增加注册护士的数量，作为持牌护理人员的比例，改变技能组合，导致costs.Conclusions的减少：研究结果提供支持的住院护士人员配置的价值，因为它有助于改善住院护理;增加工作人员的数量和技能组合，可以导致提高质量和减少住院时间在没有额外的费用。
Background: Inpatient quality deficits have important implications for the health and well-being of patients. They also have important financial implications for payers and hospitals by leading to longer lengths of stay and higher intensity of treatment. Many of these costly quality deficits are particularly sensitive to nursing care.Objective: To assess the effect of nurse staffing on quality of care and inpatient care costs.Design: Longitudinal analysis using hospital nurse staffing data and the Healthcare Cost and Utilization Project State Inpatient Databases from 2008 through 2011.Subjects: Hospital discharges from California, Nevada, and Maryland (n = 18,474,860).Methods: A longitudinal, hospital-fixed effect model was estimated to assess the effect of nurse staffing levels and skill mix on patient care costs, length of stay, and adverse events, adjusting for patient clinical and demographic characteristics.Results: Increases in nurse staffing levels were associated with reductions in nursing-sensitive adverse events and length of stay, but did not lead to increases in patient care costs. Changing skill mix by increasing the number of registered nurses, as a proportion of licensed nursing staff, led to reductions in costs.Conclusions: The study findings provide support for the value of inpatient nurse staffing as it contributes to improvements in inpatient care; increases in staff number and skill mix can lead to improved quality and reduced length of stay at no additional cost.