The Effects of Nursing on NICU Patient Outcomes

描述（由申请人提供）：极低出生体重（VLBW）婴儿，出生时体重≤ 1500 g，是最高风险的患者人群。这些婴儿在新生儿重症监护室接受治疗，在那里他们受到密切监测，并得到一系列生命支持措施和强化干预措施。虽然他们只占出生人数的1%，但VLBW婴儿占美国每年婴儿死亡人数的一半。然而，很少有人了解NICU患者结局的决定因素。目前，NICU之间的结局存在很大差异，无法用患者特征的差异来解释。医院和单位的特点，如教学状态，容量或NICU水平也解释了NICU之间观察到的患者结局的变化。为了了解和改善NICU的患者预后，必须考虑护理过程的其他方面。由于新生儿重症监护室的情况下，最护士密集型住院，护理在病人的结果的作用，有希望解释这些变化。也有证据表明，新生儿重症监护病房服务的比例不成比例的少数极低出生体重婴儿有较差的结果，同样不能解释的病人或医院/单位的特点。了解护理的作用，因此也有希望解释和解决观察到的差异，在婴儿的结果为少数民族服务的医院。有证据表明，从成年人的护理人员，护理人员的特点和护理组织的水平影响病人的结果。然而，几乎没有任何临床人群（包括新生儿重症监护室）中的急性调整人员配置数据。一项试点研究表明，新生儿重症监护病房的差异是巨大的。在本项目中，我们建议（1）通过为NICU婴儿制定护理敏锐度权重并使用该权重调整敏锐度人员配备水平来测量和描述NICU中敏锐度调整护士人员配备水平的变化（2）估计敏锐度调整护士人员配备，护理人员特征，护理实践环境和病人的结果在新生儿重症监护室和（3）探讨是否敏锐调整护士配备，护理人员的特点，或护理实践环境解释了少数民族和非少数民族服务医院之间患者结果的差异。该项目将使用来自佛蒙特州牛津网络的数据，该网络包含美国每年出生的婴儿的一半以上，并通过原始数据收集进行扩充。公共卫生相关性：在美国，婴儿死亡率主要集中在出生体重极低（1500克以下）的婴儿中，少数民族婴儿的死亡率更高。这项研究将提供新的知识，在新生儿重症监护室的护理对死亡率和发病率在极低出生体重婴儿在美国。该项目还将提供关于护理在解释和解决在少数民族服务医院治疗的极低出生体重婴儿的婴儿结局中观察到的差异方面的潜在作用的新知识。

DESCRIPTION (provided by applicant): Very low birth weight (VLBW) infants, weighing 1500 grams or less at birth, are among the highest-risk patient populations. These infants are treated in neonatal intensive care units where they are closely monitored and provided with an array of life support measures and intensive interventions. While they account for only 1 percent of births, VLBW infants account for half of infant deaths in the US each year. Yet, little is understood about the determinants of patient outcomes in the NICU. Large variations in outcomes across NICUs currently exist that cannot be explained by differences in patient characteristics. Hospital and unit characteristics, such as teaching status, volume or NICU level also explain little of the observed variation in patient outcomes across NICUs. To understand and improve patient outcomes in the NICU, other aspects of the care process must be taken into consideration. Since NICU cases are among the most nurse-intensive hospitalizations, the role of nursing in patient outcomes holds promise for explaining these variations. There is also evidence that NICUs that serve a disproportionate share of minority VLBW infants have poorer outcomes that similarly cannot be explained by patient or hospital/unit characteristics. Understanding the role of nursing therefore also holds promise for explaining and addressing observed disparities in infant outcomes for minority- serving hospitals. There is evidence from adult populations that levels of nurse staffing, nursing staff characteristics and the organization of nursing influences patient outcomes. However, there is little data on acuity-adjusted staffing in any clinical population, including the NICU. A pilot study suggests that the variation in NICUs is substantial. In this project we propose to (1) measure and describe the variation in NICUs in acuity-adjusted nurse staffing levels by developing nursing acuity weights for NICU infants and using the weights to acuity-adjust staffing levels (2) estimate the relationships among acuity-adjusted nurse staffing, the characteristics of nursing staff, the nursing practice environment and patient outcomes in the NICU and (3) explore whether acuity-adjusted nurse staffing, nursing staff characteristics, or the nursing practice environment explain the differences in patient outcomes between minority and non-minority serving hospitals. The project will use data from the Vermont Oxford Network that contains over half of the infants born in the US each year augmented by primary data collections. PUBLIC HEALTH RELEVANCE: Infant mortality in the US is concentrated among infants with very low birth weights (under 1500 grams) and disproportionately affects minority infants. This research will provide new knowledge on the effect of nursing in the NICU on mortality and morbidity among VLBW infants in the US. The project will also provide new knowledge on the potential role of nursing in explaining and addressing observed disparities in infant outcomes for VLBW infants treated in minority-serving hospitals.