Care Interventions and Quality of Care in Rural and Urban Nursing Units

农村和城市护理单位的护理干预和护理质量

• 批准号: 8738304
• 负责人: Marianne Baernholdt
• 金额: $ 94.16万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2019-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8738304
• 关键词: Care; Interventions; Quality; Rural; Urban

DESCRIPTION (provided by applicant): This study addresses the Agency for Healthcare Research and Quality (AHRQ) research portfolio on patient safety. The aim of the patient safety portfolio is to identify risks and prevent patient injury associated with delivery of health care including examining effective ways to make systems changes and creating an environment within health care settings that prevents patient safety events. Pressure ulcers and falls are among the most common, preventable and costly patient safety events. Despite well-established evidence and widespread implementation of preventive care interventions national pressure ulcer rates (PUR) and fall rates (FR) remain high. Numerous studies have examined factors that improve or hinder quality of Care (QOC), including the QOC indicators PUR and FR. By and large it is understood that contextual factors are important to consider when examining PUR and FR, but there is little evidence on the longitudinal influence of contextual factors on PUR and FR. The prosed study includes contextual factors conceptualized as the nurse work environment (NWE) factors (staffing and professional nursing practice) and the environment within which the NWE resides conceptualized as the 3 levels of the health care system (community, hospital and nurse unit). The NWE factors affect nurse outcomes (satisfaction and turnover) and care interventions. Thus PUR and FR are affected by care interventions which in turn are affected by nurse outcomes and NWE factors which are impacted by community, hospital, and nursing unit characteristics. These relationships are understudied in rural hospitals. Comparisons of QOC indicators in rural and urban hospitals show mixed results suggesting other contextual factors besides location are important for QOC. Longitudinal studies, measuring context and identifying resources across the healthcare system, can elucidate these complex relationships. Building on 6 preliminary studies we propose a non-experimental longitudinal design, comparing rural and urban nursing units, using 2009-2013 (20 quarters) unit-level data from the National Database of Nursing Quality Indicators augmented with data on community and hospital characteristics from other data bases. We will first (specific aim 1) determine effects of care interventions for pressure ulcer and fall prevention on PUR and FR over 5 years. We will then add NWE factors and nurse outcomes (specific aim 2) and examine the effect NWE factors and nurse outcomes have on the relationships of care interventions and PUR and FR. Finally we will (specific aim 3) determine rural and urban differences in the effects of care interventions on PUR and FR and assess the extent to which the potential differences are attributed to NWE factors and nurse outcomes. For all 3 aims we will control for community, hospital, and nursing unit characteristics. Our study's results will inform administrative and policy strategies for examining and improving QOC in rural and urban nursing units.

描述（由申请人提供）：本研究涉及医疗保健研究和质量局 (AHRQ) 关于患者安全的研究组合。患者安全组合的目的是识别与提供医疗保健相关的风险并防止患者受伤，包括检查进行系统更改的有效方法以及在医疗保健环境中创建防止患者安全事件的环境。压疮和跌倒是最常见、可预防且代价高昂的患者安全事件。尽管有充分的证据并且广泛实施预防性护理干预措施，但全国压疮率（PUR）和跌倒率（FR）仍然很高。大量研究探讨了改善或阻碍护理质量 (QOC) 的因素，包括 QOC 指标 PUR 和 FR。总的来说，我们知道在检查 PUR 和 FR 时考虑环境因素很重要，但几乎没有证据表明环境因素对 PUR 和 FR 的纵向影响。这项研究包括概念化为护士工作环境 (NWE) 因素（人员配置和专业护理实践）的背景因素以及 NWE 所在的环境，概念化为医疗保健系统的 3 个层次（社区、医院和护士单位）。 NWE 因素影响护士结果（满意度和流动率）和护理干预措施。因此，PUR 和 FR 受到护理干预措施的影响，而护理干预措施又受到护士结果和 NWE 因素的影响，而 NWE 因素又受到社区、医院和护理单位特征的影响。这些关系在乡村医院中尚未得到充分研究。农村和城市医院 QOC 指标的比较结果好坏参半，表明除位置之外的其他背景因素对 QOC 也很重要。纵向研究、测量背景并识别整个医疗保健系统的资源，可以阐明这些复杂的关系。在 6 项初步研究的基础上，我们提出了一种非实验性纵向设计，使用国家护理质量指标数据库中的 2009-2013 年（20 个季度）单位级数据，并补充了其他数据库中的社区和医院特征数据，对农村和城市护理单位进行了比较。我们将首先（具体目标 1）确定 5 年来压疮和跌倒预防护理干预措施对 PUR 和 FR 的影响。然后，我们将添加 NWE 因素和护士结果（具体目标 2），并检查 NWE 因素和护士结果对护理干预与 PUR 和 FR 关系的影响。最后，我们将（具体目标 3）确定护理干预措施对 PUR 和 FR 影响的农村和城市差异，并评估潜在差异在多大程度上归因于 NWE 因素和护士结果。对于所有 3 个目标，我们将控制社区、医院和护理单位的特征。我们的研究结果将为检查和改善农村和城市护理单位的 QOC 的行政和政策策略提供信息。