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: 7212191
• 负责人: MARCELLINE RUTH HARRIS
• 金额: $ 29.31万
• 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/7212191
• 关键词: Analyzing; Nurses; Impact; Outcomes; Using

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）：IOM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，医院护士配备与患者不良结局之间存在关系。努力解决目前的护理短缺和战略周围的更大的短缺预计已受到阻碍，这些不一致的，并在研究证据的差距。这项回顾性历史队列研究通过利用马约诊所及其医院5年（2000 - 2004年）的独特数据资源来满足这些需求，在研究期间，这些数据包括25万例入院、150万个患者日和450万个患者轮班的数据。有三个目标。首先，在患者的详细程度上，我们分析了不良患者结局的频率，并测试了这些结局与目标护理时间和实际护理时间之间的差距之间的关系，以及RN、LPNS和无执照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局。其次，在单位轮班水平的分析中，我们测试了上述护士配备指标与特定轮班和单位发生的不良事件之间的关系。第三，我们提供了目标1中出现不良患者结局的患者的总成本增量估计。重要的是，我们能够调整这些结果的风险。因此，我们相信我们可以确定：a）哪些患者最有可能发生与护士配置相关的并发症（每个病人每天的小时数和工作人员的组合），B）不良结果、不良事件和护士配备之间的关联是否与报告的一样强，因此，是否应在监测系统中依赖它们来监测医院质量; c）用于分析护士敏感的患者结果的新的敏锐度调整度量;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，以确定护士的人员配备水平与病人的安全在美国医院。