Rural Hospital Nursing: Environment, Effects and Evidence

乡村医院护理：环境、影响和证据

• 批准号: 7047363
• 负责人: ROBIN P NEWHOUSE
• 金额: $ 13.3万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-01-01 至 2008-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7047363
• 关键词: behavioral /social science research tag; clinical research; health care cost /financing; health care policy; health care service evaluation; health related legal; health services research tag; health surveys; hospital analysis; hospital organization /administration; human data; interview; nursing administration; nursing care evaluation; nursing care quality; nursing personnel; outcomes research; patient safety /medical error; rural health

DESCRIPTION (provided by applicant): Decreasing financial margins in rural hospitals and the potential impact on the quality of care are urgent concerns. Nursing care is directly related to quality, and is a basic essential core service for rural hospitals. The effects of legislative initiatives, service area and hospital characteristics on rural hospital nursing are unknown. The Agency for Healthcare Research and Quality and The Institute of Medicine have identified the rural population as a high priority for research. The overall objective of this proposed study is to evaluate the effects of legislative and market influences on rural nursing structure and patient outcomes. The specific aims are to: 1) Describe the impact of legislative changes and market influences on nursing in rural hospitals of various types; and 2) Examine the relationship between rural hospital nursing and patient outcomes. First, in a survey design, nurse executives (N=331) from rural hospitals for which quality outcomes are available will complete a telephone survey to describe the impact of legislative changes and market influences on nursing in rural hospitals. Second, nurse executive survey responses will be used in a cross-sectional correlational design to examine the impact of legislative changes and market influences on nursing in various types of rural hospitals. Third, a time-series design will be used to model changes over-time in financial margins on Registered Nurse Hours Per Patient Day (RNHPPD) and risk adjusted clinical outcomes [Health Care Utilization Project Quality Indicators (QIs) and Patient Safety Indicators (PSIs)], as well as the impact over time of RNHPPD on risk adjusted clinical outcomes (QIs and PSIs). Americans are faced with the dilemma of how to improve healthcare quality and safety, while creating a less wasteful and more efficient health system. This is an urgent priority for the rural population. This study has immediate significance for rural hospitals and rural hospital nursing through the identification of legislative initiatives, service area characteristics, hospital characteristics and nursing factors in rural hospitals that are related to quality of care. Study results will enable subsequent interventions to focus on improvement opportunities in rural hospitals. This project has promising potential to improve quality of care to the rural population using the novel approach of focusing on an understudied area, nursing in rural hospitals.

描述（由申请人提供）：迫切需要关注农村医院的财务利润以及对护理质量的潜在影响。护理与质量直接相关，并且是农村医院的基本基本核心服务。立法举措，服务区和医院特征对农村医院护理的影响尚不清楚。医疗保健研究与质量机构和医学研究所已将农村人口确定为研究的重中之重。这项拟议的研究的总体目的是评估立法和市场影响对农村护理结构和患者结果的影响。具体目的是：1）描述立法变化和市场影响对各种类型的乡村医院的护理的影响； 2）检查农村医院护理与患者结局之间的关系。首先，在调查设计中，来自农村医院的护士高管（N = 331）将完成一项电话调查，以描述立法变更和市场影响对农村医院护理的影响。其次，护士执行调查的答复将用于横断面相关设计中，以检查立法变更和市场影响对各种类型的农村医院护理的影响。第三，时间序列设计将用于对每年注册护士小时时间（RNHPPD）的财务利润率进行加班和调整的风险调整后的临床结果进行建模[医疗保健利用率项目质量指标（QIS）和患者安全指标（PSIS）]，以及RNHPPD对RNHPPD对风险调整后的临床临床影响的影响（QIS和PSIS）的影响（QIS和PSIS）。美国人面临着如何改善医疗保健质量和安全性的困境，同时创造了一个浪费较低，更有效的医疗系统。对于农村人口而言，这是一个紧迫的优先事项。这项研究通过确定与护理质量有关的农村医院中的立法计划，服务区特征，医院特征和护理因素，对农村医院和农村医院护理具有直接的意义。研究结果将使随后的干预措施专注于农村医院的改善机会。该项目具有有希望的潜力，可以利用专注于乡村医院的护理的新型方法来提高农村人口的护理质量。