NURSE STAFFING AND QUALITY OF CARE

护士人员配置和护理质量

• 批准号: 6185369
• 负责人: Jack Needleman
• 金额: $ 31.61万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-07-01 至 2003-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6185369
• 关键词: health care cost /financing; health services research tag; hospital patient care; human data; managed care; nursing care evaluation; nursing care quality; outcomes research; patient care management

The objective of this study is to assess changes in hospital nurse staffing, and analyze the relationship between hospital staffing and the quality of patient care over time. With the transformation of health care financing and the growth of per case and capitation payment, hospital are under strong pressure to cut length of stay and reduce inpatient days. This increases the amount of nursing needed per patient day. At the same time, pressures to control costs encourage hospitals to restrict growth in nurse staffing. It has been asserted, however, inadequate growth in staffing and shifts from RN to other nursing and non-nursing personnel place patients at greater risk of experiencing adverse outcomes or events. This study will: 1) describe changes in hospital nurse staffing over time; 2) compile a set of adverse nurse sensitive events and describe changes in the rates at which these outcomes occur over time; 3) determine whether there is a relationship between the rates of adverse nurse sensitive events and the level and mix of nursing and non-nursing personnel in hospitals; and 4) determine whether changes in nursing levels and mix are associated with increased market pressures on hospital or changes in managed care. In order to accomplish these goals, we will apply existing methods to adjust nursing staff levels to account for changes in case complexity and declining LOS. Additionally, we will develop, assess and improve methods available for measuring adverse nurse sensitive events, staffing levels and patient acuity so that staffing, adverse events and their relationship can be routinely monitored using widely available public data. This analysis will be conducted using data for 1987-1997 from state hospital discharge and hospital financial disclosure reports from California, Florida, Massachusetts, and Washington, the annual American Hospital Association survey, and data on nursing need, actual nurse staffing, and patient acuity from the Medicus Inpatient Methodologies system. Using extended longitudinal data sets will allow adequate measurement of change over time and control for hospital-specific effect.

本研究的目的是评估医院护理人员配置的变化，并分析随着时间的推移，医院人员配置和病人护理质量之间的关系。 随着医疗卫生筹资方式的转变，例均费用和按人头付费的增长，医院面临着缩短住院日和缩短住院日的巨大压力。 这增加了每个病人每天所需的护理量。 与此同时，控制成本的压力促使医院限制护士人数的增长。 然而，有人断言，人员配置增长不足，以及从RN到其他护理和非护理人员的转变，使患者面临更大的不良结局或事件风险。 这项研究将：1）描述医院护士人员配置随时间的变化; 2）编制一组不良护士敏感事件，并描述这些结果随时间发生的比率变化; 3）确定不良护士敏感事件的比率与医院护理和非护理人员的水平和组合之间是否存在关系;以及4）确定护理水平和组合的变化是否与医院市场压力的增加或管理式护理的变化有关。 为了实现这些目标，我们将应用现有的方法来调整护理人员的水平，以考虑到案件的复杂性和不断下降的LOS的变化。 此外，我们将开发、评估和改进用于测量不良护士敏感事件、人员配备水平和患者紧急程度的方法，以便使用广泛可用的公共数据对人员配备、不良事件及其关系进行常规监测。 该分析将使用1987-1997年来自加州、佛罗里达、马萨诸塞州和华盛顿的州立医院出院和医院财务披露报告的数据、美国医院协会年度调查以及来自Medicus住院方法系统的护理需求、实际护士配备和患者紧急程度的数据进行。 使用扩展的纵向数据集将允许充分测量随时间的变化，并控制医院特定的影响。

项目成果

Measuring hospital quality: can medicare data substitute for all-payer data?

衡量医院质量：医疗保险数据可以替代所有付款人数据吗？

• DOI: 10.1111/j.1475-6773.2003.00189.x
• 发表时间: 2003
• 期刊: Health services research
• 影响因子: 3.4
• 作者: Needleman,Jack;Buerhaus,PeterI;Mattke,Soeren;Stewart,Maureen;Zelevinsky,Katya
• 通讯作者: Zelevinsky,Katya