DETERMINANTS OF NURSING CARE COSTS AND PATIENT OUTCOMES

这项提案的总体目标是描述选定的患者和 影响护理成本的结构性特征 社区医院。具体目标是：(1)确定整体护理如何 住院费用由患者特征(DRG， 护理诊断、病情严重程度、年龄和支付方式)护理 工作人员和医生的特征；(2)确定患者的预后 (依赖性、调整后的损失、不良事件、护理满意度 护理和自我护理知识)由患者、护理人员和 医生特征；以及(3)确定患者的预后是否 由护理费用预测。一种确定护理成本的方法 是由希格森和范斯莱克在20世纪70年代初由S(希格森和范斯莱克)开发的 Van Slyck，1982)。使用患者分类系统来产生 患者护理单元(PCU)基于护理流程，直接成本 提供护理是有决心的。间接成本从以下来源分配 其他医院费用中心得出总护理费用。方法 已修改以反映当前的护理实践和成本，并采用了 在12家中西部医院使用，其中4家已同意 参与这项研究。样本大小为200名受试者，每组10人 投射体积DRG。对数据的分析方法将是 多元回归框架中的因变量将 护理成本或病人结局的一种衡量标准。

The overall objective of this proposal is to describe selected patient and structural characteristics that influence the cost of nursing care in community hospitals. Specific aims are: (1) to determine how total nursing cost of a hospital stay is predicted by patient characteristics (DRG, nursing diagnoses, severity of illness, age, and method of payment) nursing staff and physician characteristics; (2) to determine how patient outcomes (dependency, adjusted LOS, adverse incidents, satisfaction with nursing care and self care knowledge) are predicted by patient, nursing staff and physician characteristics; and (3) to determine if patient outcomes are predicted by cost of nursing care. A method for determining nursing costs was developed by Higgerson and Van Slyck in the early 1970's (Higgerson & Van Slyck, 1982). Using a patient classification system that produces patient care units (PCU) based on the nursing process, direct costs of providing nursing care are determined. Indirect costs are allocated from other hospital cost centers to arrive at a total nursing cost. The method has been modified to reflect current nursing practice and costs and adopted for use in twelve Midwestern hospitals, four of which have agreed to participate in this study. A sample size of 200 subjects in each of 10 high volume DRGs is projected. The analytic approach to the data will be a multiple regression framework in which the dependent variable will be either a measure of nursing cost or patient outcome.