Patient Care Technician Staffing in US Hemodialysis Facilities: An Ecological Study.
Patient Care Technician Staffing in US Hemodialysis Facilities: An Ecological Study.
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美国血液透析设施的患者护理技术人员配备：一项生态研究。
DOI：
10.1016/j.xkme.2023.100782
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发表时间：
2024
期刊：
影响因子：
3.9
通讯作者：
Jaar,BernardG
中科院分区：
文献类型：
--
作者：
Plantinga,LauraC;Urbanski,Megan;Hoge,Courtney;Rickenbach,Fran;Douglas-Ajayi,Clarica;Morgan,JenniferCraft;Bender,AlexisA;Jaar,BernardG
理由与目的在美国，护理接受透析的患者的技术人员在护理接受透析的患者中起着关键的一线作用。我们试图提供一个全面的描述，并确定美国中心血液透析设施患者护理技术人员配置模式的相关性。研究设计这是一项生态学研究。使用美国肾脏数据系统确定的提供血液透析和报告患者护理技术人员配备的设施。暴露点地理、年份和设施特征，包括患者总体特征。研究结果为医院报告的患者与患者护理技术员的比率。分析方法：我们按美国各州和不同时期检查了患者对患者护理技术人员的比率，并使用校正了设施水平协变量的稳健回归，估计了与设施特征相关的患者对患者护理技术人员比率的差异。结果2019年，美国6862家医疗机构的患者对患者护理技师比率中位数为9.9（25 -75百分位数，8.2-12.0）。2019年患者对患者护理技师比例中位数因美国各州和地区而异。从2004年到2019年，患者对患者护理技术员比例中位数总体下降（从10.6降至9.9），而空缺职位的比例上升（从2.8%上升至3.5%）。调整后，较大的透析组织状态（β, - 0.42; 95% CI, - 0.61至- 0.23）和较大的设施规模（β, - 0.51; 95% CI, - 0.68至- 0.33）与较低的患者-患者护理技术员比率相关。较高的患者与注册护士之比（β, 0.80; 95% CI, 0.65-0.94）和患者与社会工作者之比（β, 0.53; 95% CI, 0.37-0.70），诊所中有执业护士或执业护士（β, 0.83; 95% CI, 0.53-1.12），以及位于贫困地区（β, 0.29; 95% CI, 0.13-0.44）均与较高的患者与患者护理技术员之比相关。调整后，在这些设施接受治疗的患者的总体患者特征通常与患者与患者护理技术员的比例无关。局限性：有限的因果推理和2019年后人员配置的潜在变化。结论美国透析机构的患者护理技术人员配置因地域、时间和设施特点而有很大差异。对美国患者护理技术人员的进一步调查是有必要的，这可能会导致更好、更稳定的透析人员配置，提高员工和患者的满意度，提高护理质量。在美国，患者护理技术人员在血液透析护理中发挥着重要作用。尽管其他血液透析护理提供者中持续的人员短缺和人员流动已被描述，但对美国患者护理技术人员的配备知之甚少。通过检查透析机构报告的国家数据，我们发现患者护理技术人员的配备随地理位置、时间的变化（近年来每位患者护理技术人员的数量减少）以及各种设施特征的变化。这些信息可用于针对患者护理技术人员配备可能更具挑战性的设施的人员招聘和保留干预措施。
Rationale & ObjectiveTechnicians caring for patients receiving dialysis play a critical, frontline role in the care of patients receiving dialysis in the United States. We sought to provide a comprehensive description and identify correlates of US in-center hemodialysis facility patient care technician staffing patterns.Study DesignThis was an ecological study.Setting & ParticipantsUS facilities providing hemodialysis and reporting patient care technician staffing, identified using the US Renal Data System.ExposuresGeography, year, and facility characteristics, including aggregated patient characteristics.OutcomesThe study outcome was facility-reported patient-to-patient care technician ratio.Analytical ApproachWe examined patient-to-patient care technician ratios by US state and over time and also estimated the differences in patient-to-patient care technician ratios associated with facility characteristics, using robust regression with adjustment for facility-level covariates.ResultsThe median patient-to-patient care technician ratio among 6,862 US facilities in 2019 was 9.9 (25th-75thpercentiles, 8.2-12.0). Median 2019 patient-to-patient care technician ratios varied substantially by US state and region. There was an overall decline (from 10.6 to 9.9) in median patient-to-patient care technician ratios from 2004 to 2019, whereas the percentage of positions that were unfilled increased (from 2.8% to 3.5%). After adjustment, large dialysis organization status (β, −0.42; 95% CI, −0.61 to −0.23) and larger facility size (β, −0.51; 95% CI, −0.68 to −0.33) were associated with lower patient-to-patient care technician ratios. Higher patient-to-registered nurse (β, 0.80; 95% CI, 0.65-0.94) and patient-to-social worker (β, 0.53; 95% CI, 0.37-0.70) ratios, presence of licensed vocational nurses or licensed practical nurses at the clinic (β, 0.83; 95% CI, 0.53-1.12), and location in a poverty area (β, 0.29; 95% CI, 0.13-0.44) were all associated with higher patient-to-patient care technician ratios. Aggregated patient characteristics of patients treated at the facilities were generally not associated with patient-to-patient care technician ratio after adjustment.LimitationsLimited causal inference and potential shifts in staffing after 2019.ConclusionsUS dialysis facilities vary considerably in their patient care technician staffing by geography, over time, and by various facility characteristics. Further investigation of US patient care technician staffing is warranted and could lead to better, more stable dialysis staffing, improved staff and patient satisfaction, and higher quality of care.Plain-Language SummaryIn the United States, patient care technicians play an important role in hemodialysis care. Although ongoing staffing shortages and turnover among other hemodialysis care providers have been described, little is known about US patient care technician staffing. Examining national data reported by dialysis facilities, we found variability in patient care technician staffing by geography, over time (with fewer patients per patient care technician in more recent years), and by various facility characteristics. This information can be used to target staff recruitment and retention interventions at facilities where patient care technician staffing may be more challenging.