Doctoral Dissertation Research: The Impact of Nurse Staffing on the Quality of Patient Care

9809464勒克莱尔本论文改进奖的目的是评估医院护理人员最近的变化及其对患者护理质量的影响。检查的人员配备变化是每一位视力调整的患者每天的护理人员水平，以及护理人员组合。质量是通过三个患者结果指标来衡量的：死亡率、再入院和感染率。受控因素包括患者的敏锐度和医院的特点。使用了三个二级数据集，两个来自宾夕法尼亚州所有医院1992-1996年的年度人员配置和使用记录，第三个来自这些医院在同一时期的所有患者记录。本研究采用两种方法对数据进行分析。重复的横断面分析评估患者结局与护士配置的关系。时间序列分析评估了在人员配备发生变化的情况下结果的百分比变化。这项研究具有直接的重要性。自1994年以来，护士和病人意识到工作人员数量和病人护理质量都在下降。然而，目前还没有关于这些变化的大规模研究。过去的研究只是横断面研究，关注的是患者死亡率。1996年，医学研究所报告在这一领域缺乏研究，并建议为其提供资金。

9809464 LeClere The objective of this dissertation improvement award is to assess the recent changes in hospital nursing staff and their impact on the quality of patient care. The staffing changes examined are levels of nursing staff per acuity-adjusted patient day, and nursing staff mix. Quality is measured through three patient outcomes indicators: mortality, readmissions and infection rates. Factors controlled for include patient acuity and hospital characteristics. Three secondary data sets are utilized, two from yearly staffing and utilization records from all Pennsylvania hospitals for 1992-1996, and the third from all patient records in these hospitals over the same period. Two methods are utilized to analyze the data. Repeated cross-sectional analysis assesses the relationship of patient outcomes to nurse staffing. Time series analysis assesses the percent change in outcomes given the changes in staffing. This research is of immediate importance. Since 1994, nurses and patients have perceived a decline in staffing levels and in the quality of patient care. Yet there has been no large-scale study of the changes. Past research has been cross-sectional only, focusing on patient mortality. In 1996, the Institute of Medicine reported a lack of research in this area and recommended its funding.