Organizing nursing to improve care quality and safety: a hybrid implementation-effectiveness study

组织护理以提高护理质量和安全：一项混合实施效果研究

• 批准号: 10268970
• 负责人: Miriam Bender
• 金额: $ 40万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10268970
• 关键词: Organizing; nursing; improve; care; quality

Project Summary A significant number of patients are harmed or die every year because of unsafe, inappropriate or inadequate healthcare delivery. The Agency for HealthCare Research and Quality has identified Registered Nurses (RNs) as a patient safety strategy for reducing patient mortality and morbidity. However, variability in research findings indicate the relationship is not as simple as `more nurses = better outcomes'. Despite the fact that RNs are the largest health workforce component, with identified potential to improve patient safety, currently no evidence-based frontline RN care model exists. The long-term goal of this research is to generate critical knowledge that enables wide-spread implementation and sustained utilization of evidence-based frontline RN care models that maximize the quality and safety of care received. One emerging model highlighted by policy makers and increasingly taken up by health systems across the nation is the Clinical Nurse Leader (CNL) care model. The purpose of this study is to estimate the CNL care model's effectiveness in impacting better care and better health. It leverages a natural experiment in 66 clinical care units in 9 hospitals across 5 states (GA, TX, MI, NC, IL) that are integrating CNLs into their frontline nursing care delivery model. A hybrid type II implementation-effectiveness study will be used to accomplish the following aims. Aim 1. Evaluate the effect of CNL-integrated care delivery on changes in nationally endorsed and standardized quality and safety outcomes including patient satisfaction, infection rates, falls, LOS, and readmissions. Quasi-experimental interrupted time series (ITS) design using regression methods to evaluate outcome change for individual units. A meta-analysis implementing multilevel random effects models will provide combined unit-specific and overall estimates of effect size for each outcome. All analysis will control for pre-intervention trends, seasonality, temporal dependence, and unit-level demographics. Aim 2. Identify characteristics of CNL implementation that are sufficient and necessary to achieve outcomes. Already collected data (surveys, interviews) will be used to identify, characterize, and measure CNL implementation in each clinical unit. Qualitative Comparative Analysis will be used to identify CNL implementation and practice characteristics that are consistently present in units with improved outcomes (sufficient conditions) and thresholds that must be in place for outcomes to occur (necessary conditions). By leveraging sophisticated analytic methods that capture the dynamic interdependency of contextual factors in nursing practice, this study will be the first to examine nursing as an organizational strategy to increase care quality and safety, to measure its effectiveness, and provide specific `recipes' of successful CNL care model configurations that health systems can match to their needs to achieve intended quality and safety outcomes.

项目摘要 每年都有相当数量的病人因为不安全、不适当或不充分的医疗服务而受到伤害或死亡。 医疗保健服务。卫生保健研究和质量机构已经确定了注册护士（RNs） 作为降低患者死亡率和发病率的患者安全策略。然而，研究的可变性 调查结果表明，这种关系并不像“更多护士=更好的结果”那么简单。尽管RNs 是最大的卫生人力组成部分，具有改善患者安全的潜力，目前没有 存在基于证据的一线RN护理模式。这项研究的长期目标是产生关键的 使循证一线RN能够广泛实施和持续利用的知识 最大限度地提高护理质量和安全性的护理模式。政策强调的一种新兴模式 临床护士长（CNL）护理是一项重要的医疗保健服务， 模型本研究的目的是评估CNL护理模式在影响更好的护理方面的有效性 和更好的健康它利用了5个州9家医院66个临床护理单位的自然实验（GA， 德克萨斯州，密歇根州，北卡罗来纳州，伊利诺伊州），正在整合CNLs到他们的一线护理服务模式。混合型II 执行效果研究将用于实现以下目标。目标1.效果评价 CNL-关于国家认可和标准化质量和安全结果变化的综合护理提供 包括患者满意度、感染率、福尔斯、LOS和再入院。准实验中断时间 使用回归方法进行系列（ITS）设计，以评估单个单位的结果变化。一项荟萃分析 实施多水平随机效应模型将提供组合的单位特定和总体估计， 每个结果的影响大小。所有分析将控制干预前的趋势、季节性、时间性 依赖性和单位级人口统计学。目标二。确定CNL实施的特征 这是取得成果的必要和充分条件。已经收集的数据（调查、访谈）将用于 识别、表征和测量每个临床单位的CNL实施情况。定性比较分析 将用于确定CNL的实施和实践特征，这些特征在单位中始终存在 具有改善的结果（充分条件）和阈值，这些阈值必须到位以使结果发生 （必要条件）。通过利用复杂的分析方法， 在护理实践中的背景因素的相互依赖性，这项研究将是第一次检查护理作为一个 组织战略，以提高护理质量和安全，衡量其有效性，并提供具体的 卫生系统可以根据其需要实现的成功的CNL护理模式配置的“配方” 预期的质量和安全结果。