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，出生时体重不超过1500克，是高危患者群体之一。这些婴儿在新生儿重症监护病房接受治疗，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。虽然他们只占新生儿的1%，但极低出生体重婴儿每年占美国婴儿死亡人数的一半。然而，对NICU患者预后的决定因素知之甚少。目前，不同NICU之间的结果存在很大差异，不能用患者特征的差异来解释。医院和单元的特征，如教学状态、容量或NICU水平，也解释不同NICU之间观察到的患者结局的差异。为了了解和改善NICU患者的预后，必须考虑护理过程的其他方面。由于NICU病例是最需要护士密集住院的病例之一，护理在患者结局中的作用有望解释这些差异。也有证据表明，为少数VLBW婴儿提供不成比例服务的NICU结局较差，同样不能用患者或医院/单位的特点来解释。因此，了解护理的作用也有望解释和解决少数族裔医院观察到的婴儿结局差异。有来自成人人群的证据表明，护士的配置水平、护理人员的特征和护理组织会影响患者的预后。然而，几乎没有关于任何临床人群(包括NICU)的视力调整人员配置的数据。一项初步研究表明，NICU的差异是巨大的。在这个项目中，我们建议(1)通过为NICU婴儿制定护理敏感度权重并使用这些权重来评估和描述NICU中敏感度调整的护士人员配备水平的变化；(2)估计NICU中敏感度调整的护士人员配备、护理人员的特征、护理实践环境和患者结果之间的关系；(3)探索敏感度调整的护士人员配备、护理人员特征或护理实践环境是否可以解释少数族裔和非少数族裔服务医院之间患者结果的差异。该项目将使用佛蒙特州牛津网络的数据，该网络包含了每年超过一半的美国出生的婴儿，并通过初步数据收集进行了增强。与公共卫生相关：在美国，婴儿死亡率集中在出生体重极低(1500克以下)的婴儿中，对少数族裔婴儿的影响不成比例。这项研究将为NICU护理对美国极低出生体重儿死亡率和发病率的影响提供新的知识。该项目还将提供有关护理在解释和解决在少数族裔服务医院治疗的极低出生体重儿中观察到的婴儿结局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.