The impact of specialty nursing certification on patient outcomes and costs in acute care: An individual value-added performance analysis

专业护理认证对急症护理患者结果和成本的影响：个人增值绩效分析

• 批准号: 10735032
• 负责人: Deena Kelly Costa
• 金额: $ 39.19万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10735032
• 关键词: impact; specialty; nursing; certification; patient

Contact PD/PI: Yakusheva, Olga PROJECT SUMMARY Specialty registered nurse (RN) certifications can be a popular choice for practicing RNs to to advance their knowledge and expertise and are one way hospitals invest in their nursing workforce. An estimated 40% of acute care RNs hold specialty certification and as many as 55% of hospitals offer tuition reimbursement and paid time off for completion potentially costing organizations several mission dollars annually. While RN specialty certification is a multi-million dollar industry, surprisingly little evidence exists about the value added by RN specialty certifications in terms of improved nurse performance and patient and organizational outcomes. Evidence that does exist is inconclusive and judged as low quality due to cross-sectional study designs, aggregation of data at the hospital- or unit-level, and poor quality of certifications data in most hospital human resource databases. Lack of robust evidence may lead to broad-scale under- (or over-) investment in specialty RN certification in the healthcare industry, potentially contributing to excessive costs and suboptimal patient outcomes. In collaboration with the 4th largest healthcare system in the United States (CommonSpirit Health, over 140 hospitals across 21 states), we will conduct nurse-patient linked analyses of the impact of RN specialty certification on nurse performance, patient outcomes, and costs. Our proposal draws on our team’s prior and current expertise in nurse-patient linked analyses of electronic health record data, individual nurse value-added performance measurement, and quasi-experimental regression methods for causal inference (i.e. difference-in-difference with time-varying treatment effects). In Aim 1, we will determine whether RN specialty certifications improve nurse performance using a one-nurse-to-many-patients linking approach we developed, allowing us to test the causal effect of obtaining a specialty certification on nurse performance and whether the effect of specialty certification on nurse performance depends on the type of certification (e.g. critical care, medical-surgical, wound/ostomy) and on nurse characteristics (education, experience). In Aim 2, using a one- patient-to-many-nurses linking approach we have developed, we will determine if patient outcomes and organizational financial outcome improve with a higher proportion of specialty-certified nurses; this Aim allow us to examine whether patients who receive a greater proportion of care from specialty certified nurses have improved outcomes and lower costs, and the financial impact (cost-benefit) of increasing the proportion of specialty certified nurses in different types of organizations (e.g. Magnet/non-Magnet, teaching/non-teaching). In Aim 3, we will explore the contexts and mechanisms that support or hinder the impact of specialty nurse certification on patients, costs, and organizational outcomes, through focus groups and interviews with nurses and nurse leaders. Taken together the aims of this mixed methods study will provide the most robust, causal, and generalizable evidence to inform investments in nurse human capital to optimize nurse performance, achieve targeted patient outcomes, and reduce costs of care. Project Summary/Abstract Page 7

联系PD/PI：Yakusheva，Olga 项目总结 专科注册护士(RN)证书可以是执业RN的热门选择，以提高他们的 知识和专业知识是医院对护理人员进行投资的一种方式。据估计，40%的 急性护理RN拥有专科认证，多达55%的医院提供学费报销和 带薪完成工作可能使各组织每年花费数美元执行任务。而RN 专业认证是一个价值数百万美元的行业，令人惊讶的是，关于其附加值的证据很少 通过RN专科认证，改善护士绩效以及患者和组织 结果。由于横断面研究，确实存在的证据是不确定的，被认为是低质量的 医院或单位级别的设计、数据聚合，以及大多数医院的认证数据质量较差 人力资源数据库。缺乏强有力的证据可能会导致大规模的投资不足(或过度投资) 医疗保健行业的专业RN认证，可能会导致成本过高和次优 病人的结果。与美国第四大医疗保健系统(Commonspirity)合作 健康，21个州的140多家医院)，我们将对RN的影响进行护士-患者联系的分析 关于护士表现、患者结果和成本的专业认证。我们的建议借鉴了我们团队的 护士个人在电子健康记录数据的护士-患者关联分析方面的先前和当前专业知识 增值业绩衡量和用于因果推断的准实验回归方法(即： 具有随时间变化的治疗效果的差异性)。在目标1中，我们将确定RN专业 使用我们开发的一名护士对多名患者的链接方法，认证可以提高护士的绩效， 使我们能够测试获得专科认证对护士表现的因果关系，以及 专科认证对护士绩效的影响取决于认证的类型(例如危重护理、 医疗-外科、伤口/造口)和护士特点(教育、经验)。在《目标2》中，使用1- 我们已经开发了患者对多名护士的联系方法，我们将确定患者的预后和 通过更高比例的专科认证护士，组织的财务结果得到改善；这一目标允许 美国将检查接受专业认证护士护理的患者是否有 改善结果和降低成本，以及增加以下方面的比例的财务影响(成本效益) 不同类型组织(例如，磁体/非磁体、教学/非教学)的专业认证护士。 在目标3中，我们将探索支持或阻碍专科护士影响的背景和机制 通过焦点小组和与护士的访谈，对患者、成本和组织结果进行认证 和护士领导。总而言之，这项混合方法研究的目的将提供最可靠、最因果、 和一般性证据，为护士人力资本投资提供信息，以优化护士绩效， 实现有针对性的患者结果，并降低护理成本。 项目摘要/摘要第7页