Changes in Hospital Care Organization and Outcomes

描述(由申请人提供)：K08临床科学家导师奖的目的是为Ann Kutney Lee博士独立的医疗服务研究生涯做准备，特别是护理结果研究。职业发展计划需要三种方法来实现候选人的近期和长期职业目标，包括：1)完成致力于获得先进卫生服务研究方法和统计方面的技能的培训，并获得慢性病领域的更多内容知识；2)招募包括Linda Aiken博士、FAAN博士、RN博士、Mary Nayler博士、博士、FAAN博士、RN博士和Jeffrey Silber博士在内的专家指导团队；以及3)进行一项研究，以评估医院护理组织和患者特征(特别是慢性病)的变化对患者和护士结果的纵向影响，这将导致未来的R系列拨款申请。该研究项目将寻求了解随着时间的推移，患者和护士的结果可能如何与医院护理组织的变化(包括护士人员配置和执业环境)以及医院患者群体复杂性的变化有关。本研究将采用回溯性、观察性、两阶段的小组设计，使用二次数据来源评估护士人员配置、执业环境和患者特征的变化对患者和护士结果的纵向影响。将采用医院和患者层面的分析来评估医院护理组织和患者特征的变化对选定的患者和护士结果的影响。该研究项目的具体目标是：1)研究医院内护士人员配备、护士执业环境和患者特征随时间的变化对内外科患者结局的影响；2)考察医院内护士人员配备、护士执业环境和患者特征随时间的变化对与护士留用相关的护理结果的影响。将探索各种患者结果，包括AHRQ的患者安全指标和一种名为延长住院时间的新结果衡量标准。护士的结果将包括工作满意度、职业倦怠和离职意向。该提案将协助政策制定者和管理人员评估人口健康变化的影响，包括慢性病患病率的增加，以及系统变化对患者结局和医院护理质量的影响。这项研究还将提供对护理投资最有益于结果的初步了解。

DESCRIPTION (provided by the applicant): The purpose of this K08 Mentored Clinical Scientist Award is to prepare Dr. Ann Kutney Lee for an independent health services research career, with a special focus on nursing outcomes research. The career development plan entails three approaches to achieve the immediate and long-term career goals of the candidate, including: 1) the completion of training dedicated to acquiring skills in advanced health services research methods and statistics, and gaining additional content knowledge in the area of chronic illness, 2) the enlistment of an expert mentorship team including Drs. Linda Aiken, PhD, FAAN, RN, Mary Naylor, PhD, FAAN, RN, and Jeffrey Silber, MD PhD, and 3) the conduct of a study to evaluate the longitudinal effects of changes in hospital care organization and patient characteristics (specifically chronic conditions), on patient and nurse outcomes, that will lead to future R-series grant applications. The research project will seek to understand how patient and nurse outcomes over time may be a function of both changes in hospital care organization, including nurse staffing and practice environments, and changes in the complexity of hospital patient populations. This study will employ a retrospective, observational, two-stage panel design to assess longitudinal effects of changes in nurse staffing, practice environments, and patient characteristics on patient and nurse outcomes using secondary data sources. Hospital- and patient-level analyses will be employed to assess the effect of changes in hospital care organization and patient characteristics on the selected patient and nurse outcomes. The specific aims of the research project are: 1) to examine the effect of changes over time in nurse staffing, nurse practice environments and patient characteristics within hospitals on medical-surgical patient outcomes, and 2) to examine the effect of changes over time in nurse staffing, nurse practice environments, and patient characteristics within hospitals on nurse outcomes related to nurse retention. A variety of patient outcomes will be explored, including AHRQ's Patient Safety Indicators and a novel outcome measure called prolonged length of stay. Nurse outcomes will include job satisfaction, burnout and intentions to leave. This proposal will assist policymakers and administrators in the assessment of the impact of changing population health, including the increased prevalence of chronic health conditions, as well as system changes on patient outcomes and hospital quality of care. This study also will provide a preliminary understanding of what investments in nursing are most beneficial to outcomes.