Changes in Hospital Care Organization and Outcomes

描述（由申请人提供）：这个K08指导临床科学家奖的目的是准备博士安Kutney李独立的卫生服务研究生涯，特别关注护理成果研究。职业发展计划需要采取三种办法来实现候选人的近期和长期职业目标，包括：1）完成专门用于获得先进卫生服务研究方法和统计技能的培训，并获得慢性病领域的额外内容知识，2）招募专家导师团队，包括琳达艾肯博士，FAAN，RN，玛丽内勒博士，FAAN，RN和Jeffrey Silber，MD PhD，以及3）进行一项研究，以评估医院护理组织和患者特征（特别是慢性疾病）变化对患者和护士结果的纵向影响，这将导致未来的R系列补助金申请。该研究项目将寻求了解患者和护士的结果如何随着时间的推移可能是医院护理组织变化的函数，包括护士人员配置和实践环境，以及医院患者人群复杂性的变化。本研究将采用回顾性、观察性、两阶段面板设计，使用次要数据源评估护士人员配置、执业环境和患者特征变化对患者和护士结局的纵向影响。医院和病人水平的分析将被用来评估医院护理组织和病人特征的变化对选定的病人和护士的结果的影响。研究项目的具体目的是：1）检查随着时间的推移，在医院内的护士人员，护士执业环境和患者特征的变化对内外科患者的结果的影响，和2）检查随着时间的推移，在护士的人员，护士执业环境，和患者特征的变化对护士的结果与护士保留相关的医院内。将探讨各种患者结局，包括AHRQ的患者安全指标和一种称为延长住院时间的新结局指标。护士的结果将包括工作满意度，倦怠和打算离开。该提案将协助决策者和管理人员评估不断变化的人口健康状况的影响，包括慢性病患病率的增加，以及系统变化对患者结果和医院护理质量的影响。这项研究还将提供一个初步的了解，在护理投资是最有益的结果。

DESCRIPTION (provided by the applicant): The purpose of this K08 Mentored Clinical Scientist Award is to prepare Dr. Ann Kutney Lee for an independent health services research career, with a special focus on nursing outcomes research. The career development plan entails three approaches to achieve the immediate and long-term career goals of the candidate, including: 1) the completion of training dedicated to acquiring skills in advanced health services research methods and statistics, and gaining additional content knowledge in the area of chronic illness, 2) the enlistment of an expert mentorship team including Drs. Linda Aiken, PhD, FAAN, RN, Mary Naylor, PhD, FAAN, RN, and Jeffrey Silber, MD PhD, and 3) the conduct of a study to evaluate the longitudinal effects of changes in hospital care organization and patient characteristics (specifically chronic conditions), on patient and nurse outcomes, that will lead to future R-series grant applications. The research project will seek to understand how patient and nurse outcomes over time may be a function of both changes in hospital care organization, including nurse staffing and practice environments, and changes in the complexity of hospital patient populations. This study will employ a retrospective, observational, two-stage panel design to assess longitudinal effects of changes in nurse staffing, practice environments, and patient characteristics on patient and nurse outcomes using secondary data sources. Hospital- and patient-level analyses will be employed to assess the effect of changes in hospital care organization and patient characteristics on the selected patient and nurse outcomes. The specific aims of the research project are: 1) to examine the effect of changes over time in nurse staffing, nurse practice environments and patient characteristics within hospitals on medical-surgical patient outcomes, and 2) to examine the effect of changes over time in nurse staffing, nurse practice environments, and patient characteristics within hospitals on nurse outcomes related to nurse retention. A variety of patient outcomes will be explored, including AHRQ's Patient Safety Indicators and a novel outcome measure called prolonged length of stay. Nurse outcomes will include job satisfaction, burnout and intentions to leave. This proposal will assist policymakers and administrators in the assessment of the impact of changing population health, including the increased prevalence of chronic health conditions, as well as system changes on patient outcomes and hospital quality of care. This study also will provide a preliminary understanding of what investments in nursing are most beneficial to outcomes.