The staffing-outcomes relationship in nursing homes
The staffing-outcomes relationship in nursing homes
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DOI：
10.1111/j.1475-6773.2007.00803.x
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发表时间：
2008-06-01
影响因子：
3.4
通讯作者：
Park, Jeongyoung
中科院分区：
文献类型：
--
作者：
Konetzka, R. Tamara;Stearns, Sally C.;Park, Jeongyoung
Objective.为了纵向评估注册护士（RN）人员配置和技能组合的变化是否会导致养老院住院医师结果的变化，同时控制人员配置的潜在内部化。最小数据集（MDS）从五个州的养老院居民评估数据与在线调查认证和报告（OSCAR）的数据从1996年到2000年合并。居民水平的纵向分析与设施固定效应和工具变量。研究的结果是压疮和尿路感染的发生率。RN人员配置是以每住院医师日的护理时间来衡量的，技能组合是以RN人员配置时间占总人员配置时间的比例来衡量的。我们使用所有季度MDS评估，这些评估在年度OSCAR数据点的120天内，得到399，206个居民级观察结果。控制人员配置的内部化增加了护理院人员配置对结果的估计影响。更多的RN人员配置显著降低了这两种不良结果的可能性。增加技能组合只会降低尿路感染的发生率。未能解释人员配置-结果关系的内隐性的研究可能会低估增加RN人员配置的好处。RN人员配备的增加可能会减少一些养老院的不良后果。使用更广泛的工具和国家样本进行更多的研究将是有益的。
Objective. To assess longitudinally whether a change in registered nurse (RN) staffing and skill mix leads to a change in nursing home resident outcomes while controlling for the potential endogeneity of staffing.Data Sources. Minimum Data Set (MDS) nursing home resident assessment data from five states merged with Online Survey Certification and Reporting (OSCAR) data from 1996 through 2000.Study Design. Resident-level longitudinal analysis with facility fixed effects and instrumental variables. Outcomes studied are incidence of pressure sores and urinary tract infections. RN staffing was measured as the care hours per resident-day and skill mix was measured as RN staffing hours as a proportion of total staffing hours.Data Extraction Method. We use all quarterly MDS assessments that fall within 120 days of an annual OSCAR data point, resulting in 399,206 resident-level observations.Principal Findings. Controlling for endogeneity of staffing increases the estimated impact of staffing on outcomes in nursing homes. Greater RN staffing significantly decreases the likelihood of both adverse outcomes. Increasing skill mix only reduces the incidence of urinary tract infections.Conclusions. Research that fails to account for endogeneity of the staffing-outcomes relationship may underestimate the benefit from increased RN staffing. Increases in RN staffing are likely to reduce adverse outcomes in some nursing homes. More research using a broader array of instruments and a national sample would be beneficial.