Panel Study of Effects of Changes in Nursing on Patient Outcomes

描述（由申请人提供）：护理变化对患者结局影响的小组研究。护理的组织和实践对患者护理和患者结局具有实质性的积极影响。由于我们的NINR赞助的研究计划自1997年以来不断资助，以组织为基础的护理干预措施，现在更经常被认为是潜在的解决方案，以质量差和不安全的护理。组织因素包括护士教育，通过优先雇用的做法和教育的好处，以雇员的护士人员编制，不断发展的“行业标准”，一直是立法的重点，人力资源政策，决定护理技能组合和护理工作环境的组织做法，培养护士的自主权和权威，将他们的教育和经验转化为有效的护理。在1999年和2006年对美国护士进行的大型多州调查中，我们采用了创新的抽样、汇总和测量方法，为大量与患者结局相关的医疗机构提供了丰富的护理信息，以记录护理与结局之间的经验关系。这些数据已被用来回答一系列令人信服的实践和政策问题的贡献护士安全，有效的护理。该应用程序是我们的研究线的有效，创新的延伸，创建了一个大型研究护理因素的变化对结果的影响，寻求确定更多的因果关系，以刺激研究中出现的建议的实施。我们将在2014年复制在2006年（和1999年在宾夕法尼亚州）在四个大州的大约665家医院和数百家养老院和家庭护理机构中进行的测量，这些测量是在国家经济衰退和实施平价医疗法案之前和之后进行的。该应用程序的强大之处在于，在创建组织观察小组时，我们可以看到变化发生在哪里以及为什么。具体目标是：1）从CA、FL、NJ和PA的护士随机样本中收集数据~ 2）检查1999年至2006年期间护士在（a）教育、（B）人员配备、（c）技能组合和（d）工作环境方面的投入随时间的组织水平变化，和2014~ 3）估计组织的影响-水平的变化，包括少数民族和慢性病患者的结果，并确定少数民族护理资源的改善是否较少服务医院已经扩大了白色和少数民族患者之间结果的差距~和4）确定护理因素在护理之家和家庭健康机构患者结果中的作用，同时考虑患者临床严重性和复杂性的变化。 拟议的研究的总体目标是确定点的相对低成本的组织杠杆的护理投入，以改善患者的治疗效果。

DESCRIPTION (provided by applicant): Panel Study of Effects of Changes in Nursing on Patient Outcomes. The organization and practice of nursing have substantial positive effects on patient care and patient outcomes. As a result of our NINR-sponsored research program continually funded since 1997, organization-based nursing interventions are now more often considered as potential solutions to poor quality and unsafe care. Organizational factors include nurse education, via preferential hiring practices and educational benefits to employees~ nurse staffing, an evolving "industry standard" that has been the focus of legislation~ human resource policies which determine nursing skill mix~ and the nursing work environment-the organizational practices fostering the autonomy and authority required for nurses to translate their education and experience into effective nursing care. In large, multi-state surveys of US nurses conducted in 1999 and in 2006, we have applied innovative sampling, aggregation, and measurement methods to provide rich information on nursing never before available for large numbers of healthcare organizations that is linked to patient outcomes to document the empirical relationship between nursing and outcomes. These data have been used to answer a range of compelling practice and policy questions about the contributions of nurses to safe, effective care. This application is an efficient, innovative extension of our line of research creating a large study of the impact of change in nursing factors on outcomes, seeking to determine more about causality in order to spur implementation of recommendations emerging from research. We will replicate in 2014 measurements made in 2006 (and 1999 in Pennsylvania) across approximately 665 hospitals and hundreds of nursing homes and home care agencies in four large states with measurement before and after the national economic downturn and the implementation of the Affordable Care Act. The great strength of the application is that in creating a panel of organizational observations, we can see where change has occurred and why. Specific aims are to: 1) Collect data from random samples of nurses in CA, FL, NJ, and PA~ 2) Examine organizational-level changes over time in nurse inputs in (a) education, (b) staffing, (c) skill mix, and (d) work environment between 1999, 2006, and 2014~ 3) Estimate the effects of organizational-level changes on outcomes for patients including minorities and those with chronic illnesses and determine whether lesser improvement in nursing resources in minority serving hospitals has widened the disparity in outcomes between white and minority patients~ and 4) Determine the effects of nursing factors in nursing home and home health agency patient outcomes while accounting for variation in patient clinical severity and complexity. The overarching aim of the proposed study is to determine points of comparatively low-cost organizational leverage of nursing inputs to improve patient outcomes.