NURSE STAFFING AND QUALITY OF CARE

医学研究所关于护士人员配备充分性的委员会得出结论，没有足够的研究将护士人员模式与患者结果联系起来。随后，国家护理研究所、卫生保健政策和研究机构以及卫生资源和服务管理局护理司发布了一项合作研究议程。本研究项目是针对“卫生保健组织中的护士人员配置和护理质量”这一研究议程而设计的。本研究的目的是确定护士人员配置模式与医院护理质量之间的关系。将从美国50家社区医院获得300个患者护理单元的样本(200个内科/外科和100个重症监护)。病人护理单位一级的护士人员配置指标包括所有护理人员的护理小时数，即注册护士、注册护士、护理助理(总时数)，以及由专业护士提供的护理总时数的比例，即注册护士(工作人员组合)。患者护理质量将使用不良事件的单位比率来衡量；例如，用药错误、皮肤破裂、患者跌倒和医院感染。统计调查将收集二零零零年每季的数据。将描述护士人员配置变量的水平和这4个季度的变化。发生率和护士配置水平将按单位类型(内科/外科和重症监护)进行说明。将使用分层建模程序来确定医院级别和单位级别特征的相对影响，并检验假设：在控制了总护理小时数、患者严重程度、员工组合的单位和组织影响、患者严重程度以及单位和组织特征之后，较高的员工组合将与更高的护理质量相关，并且在员工组合和总时数之间将存在交互影响。此外，还将确定护士的特点(如学历和经验)、独立于护士人员配置的素质。将说明不同级别的总时数和工作人员组合的人员成本。这项研究大大增加了目前的文献，使用了全国范围内的大样本，同时测量了病人护理单位一级的护士人员配置，使用对护理比死亡率更敏感的指标来衡量护理质量，检查了总护理小时数和人员组合之间的相互作用。此外，分层线性模型分析将有助于描述医院层面和患者护理单元层面变量对护理质量的相对影响。

The Institute of Medicine committee on the adequacy of Nurse Staffing concluded that there is insufficient research linking nurse staff patterns and patient outcomes. Subsequently, a collaborative research agenda was released by the National Institute of Nursing Research, Agency for Health Care Policy and Research, and the Division of Nursing of the Health Resources and Service Administration. This research project was designed in response to that research agenda, "Nurse Staffing and Quality of Care in Health Care Organizations". The purpose of the study is to determine the relationship between nurse staffing patterns and quality of care in hospitals. A sample of 300 patient care units (200 medica/surgical and 100 intensive care) will be obtained from 50 community hospitals in the US. Nurse staffing indicators, at the patient care unit level, include the number of hours of care from all nursing personnel, i.e. RNs, LPNs, nursing assistants (Total Hours) and the proportion of the total hours of care from delivered by professional nurses, the RNs (Staff Mix). Patient care quality will be measured using unit rates of adverse occurrences; e.g., medication administration errors, skin breakdown, patient falls, and nosocomial infections. Data will be collected for each quarter of 2000. The levels of nurse staffing variables and the changes over the 4 quarters will be described. The rates of occurrences and the levels of nurse staffing will be described within unit type (medical/surgical and intensive care). Hierarchical modeling procedures will be used to determine the relative effects of hospital level and unit level characteristics and test the hypotheses: Higher Staff Mix will be associated with higher quality of care after controlling for Total Hours of care, patient severity and unit and organization effects of Staff Mix, patient severity, and unit and organizational characteristics, and there will be an interaction effect between Staff Mix and Total Hours. In addition, the characteristics of nurses (e.g. education and experience), quality independent of nurse staffing will be determined. The personnel costs for staffing at various levels of Total Hours and Staff Mix will be described. This study adds substantially to the current literature by using a large nationwide sample while measuring nurse staffing at the level of the patient care unit, measuring quality of care with indicators more sensitive to nursing care than mortality rates, examining the interaction between total hours of care and staff mix. In addition, hierarchical linear model analysis will assist in the description of the relative effects on the quality of care of hospital level and patient care unit level variables.