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

描述(由申请人提供)：这个K08奖项的主要目标是为Matthew McHugh博士的职业生涯做准备，致力于卫生政策环境层面的结果研究。具体地说，该奖项将为候选人提供机会：1)从事集中学习和培训，重点是对卫生政策和法规对护理质量敏感患者结果的影响进行经验性评估所需的统计方法和分析技术；2)在琳达·艾肯博士、FAAN博士、RN博士、杰弗里·西尔伯博士和马克·保利博士的指导下进行卫生政策成果研究。这项研究的具体目的是：1)确定加州最低护士与患者的人员配备比立法对风险调整后的急性心肌梗死(AMI)死亡率的影响，以及医院入住率或过度拥挤、医院市场结构以及收入水平和种族等人口特征对这一影响的影响；2)确定护士人员配备、医院入住率和医院市场结构对急性心肌梗死死亡率的影响以及这些变量之间的关系。将检验的假设是：1)在实施人员编制法后，加利福尼亚州的急性心肌梗死死亡率将低于宾夕法尼亚州的对照州。这一影响将在入院人数较多的病人身上减弱。这种影响将在医院竞争较高的地区放大，对低收入人群和少数族裔的影响将会减少，2)更好的护士配置、更低的入住率和更高的竞争水平将与较低的急性心肌梗死死亡率相关。护士人员配置对死亡率的影响将受到入住率和医院竞争的影响。 具体目标将通过使用多时间序列设计的观察性研究来实现，该设计采用差异法，使用PA作为控制状态。年内还将进行回归分析，以了解变量和感兴趣的结果之间的关系。使用基于出院摘要的管理数据可以确定入住率和入住率，这些入住率和入住率与每个患者入院的日期相匹配。这项拟议的研究将有助于确定加州立法(以及其他25个以上州正在考虑的类似法律)在医院强制规定最低护士与患者比例的影响。这项研究调查了心脏病发作患者的健康状况，心脏病发作是住院治疗的最常见原因之一。它考察了立法规定的护士与病人的比例、护士人员配备水平和医院过度拥挤可能会如何影响患者的预后。

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.