Nursing home facility risk factors for infection and hospitalization: Importance of registered nurse turnover, administration, and social factors
Nursing home facility risk factors for infection and hospitalization: Importance of registered nurse turnover, administration, and social factors
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DOI：
10.1046/j.1532-5415.2002.50610.x
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发表时间：
2002-12-01
影响因子：
6.3
通讯作者：
Magaziner, J
中科院分区：
文献类型：
--
作者：
Zimmerman, S;Gruber-Baldini, AL;Magaziner, J
目的：确定一系列广泛的结构和护理之家护理过程要素与（a）居民感染和（B）因感染住院之间的关系。设计：基线数据收集自1992年9月至1995年3月，居民随访2年;设施数据收集于随访的中点。一个分层随机抽样的59个疗养院横跨马里兰州。参与者：2015年新入院年龄65岁及以上。MEASUREMNTS：设施级数据收集与设施管理人员，护理主任，活动主任访谈;记录抽象;和直接观察。主要结果包括感染（书面诊断，抗生素治疗过程中，或肺炎的放射学确诊）和感染住院（在医疗记录上注明）。结果：2年感染率为1.20次/100住院日，感染住院率为0.17次/100住院日。除了与感染和住院相关的注册护士（RN）离职率外，不同的变量与每个结局相关。事件感染率高与更多的医疗保险接受者，高水平的物理/职业治疗师的工作人员，高执业护士的工作人员，低护士助理人员，高强度的医疗和治疗服务，痴呆症的培训，工作人员的隐私，和低水平的精神药物的使用。高感染住院率与营利性所有权、连锁关系、环境质量差、缺乏居民隐私、缺乏对工作人员满意度的管理重点以及家庭/朋友探视率低有关。调整居民的性别，年龄，种族，教育，婚姻状况，病态诊断，功能状态，和资源利用组，第三版评分没有改变护理和outcome.CONCLUSIONS的结构和过程之间的关系：RN营业额和这两个结果之间的关联强调了护理领导和护理质量在这些设置之间的关系。感染住院与营利性所有权和连锁关系之间的关系可以反映不治疗急性疾病的政策。护理的社会因素（环境质量，优先考虑工作人员的满意度，居民的隐私，和设施的访问）和住院之间的联系表明，一个非医疗模式的护理可能不会危害，实际上可能有利于健康相关的结果。所有这些设施的特点可能是可修改的，可能会影响医疗保健成本，并可能持有其他的，较少的医疗，长期护理形式的住宅的承诺。
OBJECTIVES: Determine the relationship between a broad array of structure and process elements of nursing home care and (a) resident infection and (b) hospitalization for infection.DESIGN: Baseline data were collected from September 1992 through March 1995, and residents were followed for 2 years; facility data were collected at the midpoint of follow-up.SETTING: A stratified random sample of 59 nursing homes across Maryland.PARTICIPANTS: Two thousand fifteen new admissions aged 65 and older.MEASUREMNTS: Facility-level data were collected from interviews with facility administrators, directors of nursing, and activity directors; record abstraction; and direct observation. Main outcome measures included infection (written diagnosis, a course of antibiotic therapy, or radiographic confirmation of pneumonia) and hospitalization for infection (indicated on medical records).RESULTS: The 2-year rate of infection was 1.20 episodes per 100 resident days, and the hospitalization rate for infection was 0.17 admissions per 100 resident days. Except for registered nurse (RN) turnover, which related to both infection and hospitalization, different variables related to each outcome. High rates of incident infection were associated with more Medicare recipients, high levels of physical/occupational therapist staffing, high licensed practical nurse staffing, low nurses' aide staffing, high intensity of medical and therapeutic services, dementia training, staff privacy, and low levels of psychotropic medication use. High rates of hospitalization for infection were associated with for-profit ownership, chain affiliation, poor environmental quality, lack of resident privacy, lack of administrative emphasis on staff satisfaction, and low family/friend visitation rates. Adjustment for resident sex, age, race, education, marital status, number of morbid diagnoses, functional status, and Resource Utilization Group, Version III score did not alter the relationship between the structure and process of care and outcomes.CONCLUSIONS: The association between RN turnover and both outcomes underscores the relationship between nursing leadership and quality of care in these settings. The relationship between hospitalization for infection and for-profit ownership and chain affiliation could reflect policies not to treat acute illnesses in house. The link between social factors of care (environmental quality, prioritizing staff satisfaction, resident privacy, and facility visitation) and hospitalization indicates that a nonmedical model of care may not jeopardize, and may in fact benefit, health-related outcomes. All of these facility characteristics may be modifiable, may affect healthcare costs, and may hold promise for other, less-medical, forms of residential long-term care.