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，出生时体重为1500克或以下，是高危患者人群之一。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，并获得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%，但超低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了解甚少。目前，新生儿重症监护病房的结果存在很大差异，这不能用患者特征的差异来解释。医院和单位的特点，如教学状况、容量或新生儿重症监护病房的水平，也不能解释观察到的新生儿重症监护病房患者预后的差异。为了了解和改善新生儿重症监护室患者的预后，必须考虑到护理过程的其他方面。由于新生儿重症监护室的病例是护士最密集的住院病例之一，护理在患者预后中的作用有望解释这些差异。也有证据表明，为少数极低体重婴儿提供不成比例的新生儿重症监护病房的结果较差，同样不能用患者或医院/单位特征来解释。因此，了解护理的作用也有助于解释和解决为少数民族服务的医院中观察到的婴儿结局差异。有证据表明，成年人群的护士配备水平，护理人员的特点和护理组织影响患者的结果。然而，在包括新生儿重症监护室在内的任何临床人群中，关于急性调整人员配置的数据很少。一项初步研究表明，新生儿重症监护病房的差异很大。在本项目中，我们提出(1)通过制定新生儿重症监护病房的护理敏锐度权重，并使用该权重来测量和描述新生儿重症监护病房中锐锐度调整后的护士配备水平的变化；(2)估计新生儿重症监护病房中锐锐度调整后的护士配备、护理人员特征、护理实践环境和患者预后之间的关系；(3)探讨锐锐度调整后的护士配备、护理人员特征、护理人员特征、或者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局的差异。该项目将使用来自佛蒙特牛津网络的数据，该网络包含了美国每年出生的一半以上的婴儿，并通过主要数据收集进行了扩充。公共卫生相关性：美国的婴儿死亡率集中在出生体重极低（1500克以下）的婴儿中，并且不成比例地影响少数民族婴儿。本研究将为美国新生儿重症监护室护理对VLBW婴儿死亡率和发病率的影响提供新的知识。该项目还将提供新的知识，说明护理在解释和解决在少数民族医院治疗的极低体重婴儿所观察到的婴儿结局差异方面的潜在作用。

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.