Nurse Staffing Policy, Hospital Occupancy, Market Structure, and Patient Outcomes

描述（由申请人提供）：本K08奖的主要目标是为马修·麦克休博士的职业生涯做好准备，使其成为一名致力于卫生政策环境层面成果研究的独立研究者。具体而言，该奖项将为候选人提供以下机会：1)从事集中于统计方法和分析技术的强化学习和培训，以便经验性地评估卫生政策和法规对护理质量的影响。2)在Linda Aiken博士（FAAN， RN）、Jeffrey Silber博士（MD, PhD）和Mark Pauly博士（PhD）的指导下进行一项卫生政策结果研究。本研究的具体目的是：1)确定加州最低护士与患者比例立法对风险调整急性心肌梗死（AMI）死亡率的影响，以及医院入住率或过度拥挤、医院市场结构、收入水平和种族等人口统计学特征对这种影响的影响。2)确定护士人员配置、医院入住率和医院市场结构对AMI死亡率的影响以及这些变量之间的关系。将被测试的假设是：1)在实施人员配备法后，与对照州宾夕法尼亚州相比，加利福尼亚州的AMI死亡率将更低。这种影响将减少在高占用期入院的病人。在医院竞争激烈的地区，这种影响将被放大，而对低收入者和少数族裔的影响将被减弱。2)更好的护士配备、更低的入住率和更高水平的竞争将与较低的急性心肌梗塞死亡率相关。护士配备对死亡率的影响将被入住率和医院竞争所调节。

DESCRIPTION (provided by the applicant): The primary goal of this K08 Award is to prepare Dr. Matthew McHugh for a career as an independent investigator devoted to outcomes research at the health policy environment level. Specifically, the Award will provide the candidate with the opportunity to: 1) engage in intensive study and training focused on the statistical methods and analytic techniques required to empirically evaluate the effect of health policies and regulations on quality of care-.sensitive patient outcomes, and 2) conduct a health policy outcomes study under the mentorship of Linda Aiken, PhD, FAAN, RN, Jeffrey Silber, MD, PhD, and Mark Pauly, PhD. The specific aims of this study are to: 1) determine the effect of California's minimum nurse-to-patient staffing ratio legislation on risk-adjusted acute myocardial infarction (AMI) mortality and the influence of hospital occupancy rates or overcrowding, hospital market structure, and demographic characteristics such as income level and race on this effect, and 2) determine the effects of nurse staffing, hospital occupancy rates, and hospital market structure on AMI mortality and relationship among those variables. The hypotheses that will be tested are: 1) AMI mortality will be lower in CA compared to a control state, Pennsylvania after the implementation of the staffing law. This effect will be reduced for patients admitted at periods of high occupancy. The effect will be amplified in areas of higher hospital competition and the effect will be reduced for low-income persons as well as racial minorities, and 2) Better nurse staffing, lower occupancy rates, and higher levels of competition will be associated with lower AMI mortality. The effect of nurse staffing on mortality will be moderated by occupancy rate and hospital competition. The specific aims will be accomplished through an observational study using a multiple time series design with a difference-in-differences approach, using PA as a control state. Within-year regression analyses will also be performed to understand the relationships between the variables and outcomes of interest. Using discharge abstract-based administrative data will allow determinations of occupancy and occupancy rates that match with the day each individual patient is admitted. The proposed study will help determine the impact of California legislation (and similar laws being considered in more than 25 other states) mandating minimum nurse-to-patient ratios in hospitals. The study examines health outcomes for patients admitted with heart attacks - one of the most common reasons for hospitalization. It examines how legislated nurse-to-patient ratios, nurse staffing levels, and hospital overcrowding may affect patient outcomes.