LOWER MEDICARE MORTALITY AMONG A SET OF HOSPITALS KNOWN FOR GOOD NURSING-CARE
LOWER MEDICARE MORTALITY AMONG A SET OF HOSPITALS KNOWN FOR GOOD NURSING-CARE
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DOI：
10.1097/00005650-199408000-00002
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发表时间：
1994-08-01
期刊：
影响因子：
3
通讯作者：
LAKE, ET
中科院分区：
文献类型：
--
作者：
AIKEN, LH;SMITH, HL;LAKE, ET
本研究的目的是调查是否已知的医院是很好的地方，实践护理有较低的医疗保险死亡率比医院，否则类似的各种非护理组织特征。迄今为止，关于医院死亡率决定因素的研究并没有集中在护理组织方面。我们利用了一组对39家医院的研究，这些医院由于患者结局以外的原因被选为以良好护理而闻名的医院。我们将这些“磁铁”医院与195家对照医院进行了匹配，这些对照医院选自美国所有拥有100多个医疗保险出院病例的非磁铁医院，使用多变量匹配抽样程序控制医院特征。磁铁与对照医院的医疗保险死亡率进行了比较，使用方差分量模型，该模型汇集了每个磁铁医院的五场比赛的信息，并根据预测死亡率测量的患者组成差异进行调整。磁铁医院观察到的死亡率比对照医院低7.7%（每1,000名医疗保险出院者死亡人数减少9人）（P = 0.011）。在调整了预测死亡率的差异后，磁铁医院的死亡率降低了4.6%（P = 0.026 [95%置信区间为每1,000例死亡人数减少0.9至9.4]）。从护理组织的角度来看，导致医院被认为是有效的因素与医疗保险患者的死亡率较低有关。
The objective of this study is to investigate whether hospitals known to be good places to practice nursing have lower Medicare mortality than hospitals that are otherwise similar with respect to a variety of non-nursing organizational characteristics. Research to date on determinants of hospital mortality has not focused on the organization of nursing. We capitalize on the existence of a set of studies of 39 hospitals that, for reasons other than patient outcomes, have been singled out as hospitals known for good nursing care. We match these ''magnet'' hospitals with 195 control hospitals, selected from all nonmagnet U.S. hospitals with over 100 Medicare discharges, using a multivariate matched sampling procedure that controls for hospital characteristics. Medicare mortality rates of magnet versus control hospitals are compared using variance components models, which pool information on the five matches per magnet hospital, and adjust for differences in patient composition as measured by predicted mortality. The magnet hospitals' observed mortality rates are 7.7% lower (9 fewer deaths per 1,000 Medicare discharges) than the matched control hospitals (P = .011). After adjusting for differences in predicted mortality, the magnet hospitals have a 4.6% lower mortality rate (P =.026 [95% confidence interval 0.9 to 9.4 fewer deaths per 1,000]). The same factors that lead hospitals to be identified as effective from the standpoint of the organization of nursing care are associated with lower mortality among Medicare patients.