Analyzing Nurses' Impact on Outcomes Using Detailed Data

使用详细数据分析护士对结果的影响

• 批准号: 7095810
• 负责人: MARCELLINE RUTH HARRIS
• 金额: $ 29.67万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-01 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7095810
• 关键词: allied health personnel; behavioral /social science research tag; clinical research; decubitus ulcer; health care personnel performance; health care service evaluation; health science manpower; health services research tag; hospital patient care; human data; human mortality; nurses; nursing care; nursing personnel; outcomes research; patient safety /medical error

DESCRIPTION (Provided by the Applicant): Reports by the IOM have focused national attention on the quality and safety of hospital care. There is increasing but inconsistent evidence of a relationship between hospital nurse staffing and adverse patient outcomes. Efforts to address both the current nursing shortage and to strategize around the much larger shortage projected have been hampered by these inconsistencies, and by gaps in the research evidence. This retrospective historical cohort study addresses these needs by taking advantage of 5-years (2000 - 2004) of the unique data resources of Mayo Clinic and its hospitals, which over the study period include data on 250,000 admissions, 1.5 million patient days, and 4.5 million patient shifts. There are three aims. First, at the patient level of detail, we analyze the frequency of adverse patient outcomes and test the relationship between these outcomes and the gap between targeted and actual hours of nursing care, as well as the mix of RNs, LPNS, and unlicensed patient care assistants and predict which patients are most likely to experience these outcomes. Second, at the unit-shift level of analysis, we test for relationships between the measures of nurse staffing identified above and adverse events that occur on a specific shift and unit. Third, we provide estimates of the incremental increases in total costs for patients who experience the adverse patient outcomes in aim 1. Importantly, we are able to risk adjust these outcomes. As a result, we believe we can determine: a) which patients are most at risk for experiencing a complication related to nurse staffing (both hours per patient day and staff mix), b) whether associations between adverse outcomes, adverse events, and nurse staffing are as strong as reported, and hence, whether they should be relied upon in surveillance systems for monitoring hospital quality; c) a new acuity adjustment metrics for use in analyzing nurse sensitive patient outcomes; and d) outcomes and their associated costs at discharge and within 30 days follow-up. Subsequently, this study can provide heretofore missing evidence needed to define nurse staffing levels associated with patient safety in U.S. hospitals.

描述(由申请人提供)：国际移民组织的报告将全国的注意力集中在医院护理的质量和安全上。有越来越多但不一致的证据表明，医院护士的配备与不利的患者结局之间存在关系。解决目前护理短缺的努力和围绕预计的更大短缺制定战略的努力，受到这些不一致以及研究证据中的差距的阻碍。这项回溯性的历史队列研究通过利用梅奥诊所及其医院5年(2000-2004年)的独特数据资源来满足这些需求，这些数据资源在研究期间包括25万入院人数、150万病人日和450万病人轮班的数据。有三个目标。首先，在患者层面，我们分析患者不良结果的频率，测试这些结果与目标护理和实际护理时间之间的差距，以及RN、LPN和无证患者护理助理的组合，并预测哪些患者最有可能经历这些结果。其次，在单位轮班水平的分析中，我们测试上述护士人员配备的衡量标准与发生在特定班次和单位的不良事件之间的关系。第三，我们提供了对在AIM 1中经历不良患者结果的患者的总成本增量增加的估计。重要的是，我们能够冒险调整这些结果。因此，我们相信我们可以确定：a)哪些患者最有风险经历与护士人员配备相关的并发症(患者每天的工作时间和人员组合)，b)不良结果、不良事件和护士人员配备之间的关联是否如报道的那样强烈，因此，它们是否应该被用于监测医院质量的监测系统；c)用于分析护士敏感患者结果的新的敏感度调整指标；以及d)出院时和30天内随访的结果及其相关成本。随后，这项研究可以提供迄今为止缺失的证据，以确定美国医院中与患者安全相关的护士人员配备水平。