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

联系PD/PI：Yakusheva，Olga 项目摘要 专业注册护士（RN）认证可以是执业RN的热门选择，以提高他们的 知识和专业知识，是医院投资于护理人员的一种方式。估计有40%的 急性护理RN持有专业认证，多达55%的医院提供学费报销， 完成任务的带薪休假可能每年花费组织几个使命美元。当RN 专业认证是一个价值数百万美元的行业，令人惊讶的是，几乎没有证据表明其增值 通过RN专业认证，改善护士绩效，患者和组织 结果。确实存在的证据是不确定的，由于横断面研究而被判定为低质量 设计、医院或单位层面的数据汇总以及大多数医院认证数据的质量差 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）， 医疗保健行业的专业RN认证，可能导致成本过高， 患者结局。与美国第四大医疗保健系统（CommonSpirit）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-患者相关分析 专业认证的护士表现，病人的结果，和成本。我们的提案借鉴了我们团队的 先前和当前在电子健康记录数据的护士-患者关联分析方面的专业知识， 增值性能测量，以及用于因果推理的准实验回归方法（即， 具有随时间变化的处理效果的差异中的差异）。在目标1中，我们将确定RN专业是否 通过我们开发的一个护士对多个患者的联系方法，认证提高了护士的绩效， 允许我们测试获得专业认证对护士表现的因果关系，以及 专业认证对护士表现的影响取决于认证的类型（例如重症监护， 内科-外科、伤口/造口术）和护士特征（教育、经验）。在目标2中，使用1- 我们已经开发了一种患者与多名护士联系的方法，我们将确定患者的结果和 组织的财务结果改善与专业认证护士的比例较高;这一目标允许 我们要研究的是，接受专科认证护士护理比例较大的病人， 改善成果和降低成本，以及增加 不同类型组织的专业认证护士（例如磁铁/非磁铁，教学/非教学）。 在目标3中，我们将探讨支持或阻碍专科护士影响的背景和机制 通过焦点小组和护士访谈对患者、成本和组织成果进行认证 护士长总之，这种混合方法研究的目的将提供最强大的，因果关系， 和可推广的证据，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

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