The Impact of Nursing Workforce Organization on Outcomes of Hospitalized Children

描述（由申请人提供）：儿童质量结局存在医院差异，但尚未充分了解。医院护理人力组织的某些特征-护士工作量，护士教育和护士执业环境-与住院成人的更好的结果相关。目前尚不清楚这些关系是否适用于儿科。此外，目前尚不清楚儿童医院和综合医院之间儿科结局的差异是否可以部分解释为护理人员组织。这项横断面观察性研究将：1）在控制患者和医院特征后，确定护理人员组织与因常见内科和外科疾病住院的儿童结局的相关程度; 2）比较综合医院和儿童医院治疗的儿童结局，并在存在差异的情况下，确定护理人员组织与儿童结局的相关程度。 劳动力组织是造成这些差异的原因。医院管理数据，国家级患者 出院数据和先前从加州、佛罗里达、新泽西和宾夕法尼亚州的注册护士收集的护士调查数据将合并在一起，以形成用于二次分析的分析数据集。样本中估计有259家医院，32，000名护士和96，000名儿科患者。关注的结局-延长住院时间（PLOS）、有条件住院时间（CLOS）和再入院-将使用logistic和线性回归进行检查，以医院作为观察单位。该研究的结果对提高向儿童提供的住院护理质量产生了影响，儿童是AHRQ的优先人群。 医院儿科住院服务的质量和患者安全存在差异，这是一个重大的公共卫生问题。预计这项拟议的研究将提供有关护理与儿科患者结局之间关系的重要信息，从而为这一弱势患者群体提供安全的医院护理。

DESCRIPTION (provided by applicant): Hospital variation in quality outcomes for children exists, though it is not well understood. Certain characteristics of hospital nursing workforce organization - nurse workload, nurse education, and the nurse practice environment - are associated with better outcomes for hospitalized adults. It is not known whether these relationships hold in pediatrics. Additionally, it is unknown whether differences in pediatric outcomes between children's and general hospitals can be partially explained by nursing workforce organization. This cross-sectional, observational study will: 1) determine the extent to which nursing workforce organization is associated with outcomes for children hospitalized with common medical and surgical conditions after controlling for patient and hospital characteristics; and 2) compare outcomes for children treated in general hospitals and children's hospitals and, where differences exist, to determine the extent to which nursing Workforce organization accounts for these differences. Hospital administrative data, state-level patient discharge data, and previously collected nurse survey data from Registered Nurses in California, Florida, New Jersey, and Pennsylvania will be merged together to form an analytic dataset for secondary analysis. There are an estimated 259 hospitals, 32,000 nurses, and 96,000 pediatric patients in the sample. The outcomes of interest - prolonged length of stay (PLOS), conditional length of stay (CLOS), and readmission - will be examined using logistic and linear regression with the hospital as the unit of observation. The findings of the study have the impact to improve the quality of inpatient care delivered to children, an AHRQ priority population. It is a major public health problem that there is variation in the quality and patient safety of inpatient pediatric services in hospitals. It is anticipated that the proposed study will provide important information about relationships between nursing care and pediatric patient outcomes, enhancing the provision of safe hospital care for this vulnerable patient population.