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

护士人员配置政策、医院入住率、市场结构和患者治疗结果

• 批准号: 7688529
• 负责人: Matthew D. McHugh
• 金额: $ 12.35万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-30 至 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7688529
• 关键词: Nurse; Staffing; Policy; Hospital; Occupancy

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.

描述（由申请人提供）：这个K 08奖的主要目标是准备博士马修·麦克休的职业生涯作为一个独立的研究人员致力于在卫生政策环境水平的结果研究。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密集研究和培训，以经验评估卫生政策和法规对护理质量的影响-敏感的患者结果，以及2）在琳达艾肯博士，FAAN，RN，杰弗里西尔伯，医学博士，博士的指导下进行卫生政策结果研究，和马克·保利博士这项研究的具体目标是：1）确定加州的最低护士与患者人员配置比例立法对风险调整的急性心肌梗死（AMI）死亡率的影响，以及医院入住率或过度拥挤、医院市场结构和人口统计学特征（如收入水平和种族）对该影响的影响，以及2）确定护士人员配置、医院入住率、和医院市场结构对AMI死亡率的影响及其相互关系。将被检验的假设是：1）在实施人员配备法后，与对照州宾夕法尼亚州相比，CA的AMI死亡率将较低。对于在高入住率期间入院的患者，这种影响将减少。在医院竞争激烈的地区，这种影响将被放大，而对低收入人群和少数民族的影响将被降低; 2）更好的护士配备、更低的入住率和更高的竞争水平将与更低的AMI死亡率相关。护士配置对死亡率的影响将受到医院入住率和医院竞争的影响。 具体目标将通过一项观察性研究来实现，该研究采用多时间序列设计，采用差异中差异方法，将PA作为对照状态。还将进行年内回归分析，以了解变量与关注结局之间的关系。使用基于出院摘要的管理数据将允许确定与每个患者入院当天相匹配的入住率和入住率。这项拟议中的研究将有助于确定加州立法（以及其他25个州正在考虑的类似法律）对医院最低护士与病人比例的影响。该研究检查了心脏病发作患者的健康结果-这是住院治疗的最常见原因之一。它探讨了如何立法护士与病人的比例，护士的人员配备水平，医院人满为患可能会影响病人的结果。