Hospital Unions, Staffing, Wages, and Patient Safety

医院工会、人员配备、工资和患者安全

• 批准号: 7313167
• 负责人: JOANNE E. SPETZ
• 金额: $ 29.54万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7313167
• 关键词: Hospital; Unions; Staffing; Wages; Patient

DESCRIPTION (Provided by the Applicant): In the past two decades, there has been a resurgence in union activity in the health care industry in the United States, particularly in hospitals. As health care unions become more influential in hospital operations, it is important that we better understand how unions affect health care and patient safety. This study has four specific objectives: (1) to measure the growth of hospital unions in the United States, using data at both the individual and hospital level, and to identify the factors that lead to hospital unionization; (2) to quantify the effects of hospital unions on wages, and to assess the effect of union-driven wage growth on growth in overall hospital costs; (3) to examine the relationship between unions and hospital nurse-to-patient ratios; and (4) to evaluate whether hospital unions improve patient safety and patient outcomes, both indirectly by improving working conditions and directly by improving process of care. This study will use national and state data to address the objectives, with a focus on eleven states from 1990 through 2006. The primary patient outcomes used in this study will be derived from the AHRQ Patient Safety Indicators and Inpatient Quality Indicators. The datasets to be used in this study include a dataset on unionization in hospitals to be developed in this project, the AHRQ Nationwide Inpatient Sample, the American Hospital Association Annual Survey of Hospitals, the California Office of Statewide Health Planning and Development patient and hospital data, and the US Bureau of the Census Current Population Survey. The analytical strategy used throughout this study is that of multivariate regression analysis. The research team will use econometric methods that control for differences between hospitals and the possibility that different hospital characteristics cause unionization, rather than result from unionization. This project will improve our understanding of how hospitals deliver safe, effective care to patients. Previous research has found that unionized hospitals have lower heart attack mortality rates, but at this time we do not understand why this relationship exists. This study will delve into the "black box" of hospital unionization to learn whether and how unions affect the delivery and quality of care.

描述（由申请人提供）：在过去的二十年中，美国医疗保健行业的工会活动重新兴起，特别是在医院。随着医疗保健工会在医院运营中的影响力越来越大，我们更好地了解工会如何影响医疗保健和患者安全非常重要。 这项研究有四个具体目标： (1) 使用个人和医院工会的数据来衡量美国医院工会的发展。 医院层面，并确定导致医院成立工会的因素； (2) 量化医院工会对工资的影响，并评估工会驱动的工资增长对医院总体成本增长的影响； (3)考察工会与医院护患比之间的关系；和 (4) 评估医院工会是否可以间接改善患者安全和患者治疗结果 改善工作条件并直接通过改善护理流程来改善。 本研究将使用国家和州数据来实现目标，重点关注 1990 年至 2006 年的 11 个州。本研究中使用的主要患者结果将源自 AHRQ 患者安全指标和住院患者质量指标。本研究中使用的数据集包括本项目中将开发的医院工会数据集、AHRQ 全国住院患者样本、美国医院协会医院年度调查、加州全州健康规划和发展办公室患者和医院数据以及美国人口普查局当前人口调查。本研究中使用的分析策略是多元回归分析。研究小组将使用计量经济学方法来控制医院之间的差异以及不同医院特征导致工会化的可能性，而不是工会化的结果。 该项目将提高我们对医院如何为患者提供安全、有效护理的理解。此前的研究发现，工会医院的心脏病死亡率较低，但目前我们不明白为什么存在这种关系。这项研究将深入研究医院工会的“黑匣子”，以了解工会是否以及如何影响护理的提供和质量。