The Impact of Nursing Workforce Organization on Outcomes of Hospitalized Children

描述(由申请人提供)：医院对儿童的质量结果存在差异，尽管还不是很好地理解。医院护理劳动力组织的某些特征-护士工作量、护士教育和护士执业环境-与住院成年人的更好结果相关。目前尚不清楚这些关系是否适用于儿科。此外，目前尚不清楚儿童医院和综合医院之间儿科结果的差异是否可以部分解释护理劳动力组织。这项横断面的观察性研究将：1)在控制了患者和医院的特点后，确定护理劳动力组织与患有常见内外科疾病的儿童住院的结果之间的关系；以及2)比较在综合医院和儿童医院接受治疗的儿童的结果，如果存在差异，则确定护理的程度。 员工队伍组织是造成这些差异的原因。医院管理数据，国家级患者 出院数据和以前从加利福尼亚州、佛罗里达州、新泽西州和宾夕法尼亚州的注册护士收集的护士调查数据将合并在一起，形成一个分析数据集，用于二次分析。样本中估计有259家医院、3.2万名护士和9.6万名儿科患者。以医院为观察单位，采用Logistic和线性回归分析方法，对延长住院时间(PLOS)、有条件住院时间(CLOS)和再入院时间的结果进行检验。这项研究的结果对改善儿童的住院护理质量具有影响，儿童是AHRQ优先考虑的人群。 医院儿科住院服务的质量和患者安全参差不齐，是一个重大的公共卫生问题。预计拟议的研究将提供有关护理和儿科患者结局之间关系的重要信息，加强为这一脆弱患者群体提供安全的医院护理。

DESCRIPTION (provided by applicant): Hospital variation in quality outcomes for children exists, though it is not well understood. Certain characteristics of hospital nursing workforce organization - nurse workload, nurse education, and the nurse practice environment - are associated with better outcomes for hospitalized adults. It is not known whether these relationships hold in pediatrics. Additionally, it is unknown whether differences in pediatric outcomes between children's and general hospitals can be partially explained by nursing workforce organization. This cross-sectional, observational study will: 1) determine the extent to which nursing workforce organization is associated with outcomes for children hospitalized with common medical and surgical conditions after controlling for patient and hospital characteristics; and 2) compare outcomes for children treated in general hospitals and children's hospitals and, where differences exist, to determine the extent to which nursing Workforce organization accounts for these differences. Hospital administrative data, state-level patient discharge data, and previously collected nurse survey data from Registered Nurses in California, Florida, New Jersey, and Pennsylvania will be merged together to form an analytic dataset for secondary analysis. There are an estimated 259 hospitals, 32,000 nurses, and 96,000 pediatric patients in the sample. The outcomes of interest - prolonged length of stay (PLOS), conditional length of stay (CLOS), and readmission - will be examined using logistic and linear regression with the hospital as the unit of observation. The findings of the study have the impact to improve the quality of inpatient care delivered to children, an AHRQ priority population. It is a major public health problem that there is variation in the quality and patient safety of inpatient pediatric services in hospitals. It is anticipated that the proposed study will provide important information about relationships between nursing care and pediatric patient outcomes, enhancing the provision of safe hospital care for this vulnerable patient population.