Panel Study of Effects of Changes in Nursing on Patient Outcomes

描述(由申请人提供)：护理变化对患者结局影响的小组研究。护理的组织和实施对病人的护理和病人的结局有很大的积极影响。由于我们的NINR赞助的研究项目自1997年以来一直得到资助，基于组织的护理干预现在更多地被认为是解决低质量和不安全护理的潜在解决方案。组织因素包括护士教育，通过优先雇用做法和员工的教育福利~护士人员配备，一个不断发展的“行业标准”，它一直是立法的焦点~决定护理技能组合的人力资源政策~以及护理工作环境--培养护士将其教育和经验转化为有效护理所需的自主性和权威的组织实践。在1999年和2006年对美国护士进行的大型多州调查中，我们应用了创新的抽样、汇总和测量方法，提供了大量与患者结果相关的丰富的护理信息，以记录护理与结果之间的经验关系。这些数据已经被用来回答一系列关于护士对安全、有效护理的贡献的令人信服的实践和政策问题。这一应用是我们研究路线的有效、创新的延伸，创建了一项关于护理因素变化对结果的影响的大型研究，寻求确定更多关于因果关系的信息，以促进从研究中提出的建议的实施。我们将在2014年在四个大州的大约665家医院和数百家疗养院和家庭护理机构中复制2006年(以及1999年在宾夕法尼亚州)进行的测量，并在全国经济低迷和《平价医疗法案》实施前后进行测量。这个应用程序的强大之处在于，在创建一个组织观察小组时，我们可以看到哪里发生了变化以及为什么发生了变化。具体目标是：1)从加州、佛罗里达州、新泽西州和宾夕法尼亚州的护士中随机抽样收集数据2)检查1999-2006年间(A)教育、(B)人员配备、(C)技能组合和(D)工作环境中护士投入随时间的变化，和2014~3)估计组织层面的变化对包括少数族裔和慢性病患者在内的患者预后的影响，并确定少数族裔服务医院护理资源改善较少是否扩大了白人和少数族裔患者之间的预后差异[4)确定护理因素对疗养院和家庭保健机构患者预后的影响，同时考虑到患者临床严重性和复杂性的差异。这项拟议研究的总体目标是确定相对低成本的护理投入的组织杠杆作用点，以改善患者的结果。

DESCRIPTION (provided by applicant): Panel Study of Effects of Changes in Nursing on Patient Outcomes. The organization and practice of nursing have substantial positive effects on patient care and patient outcomes. As a result of our NINR-sponsored research program continually funded since 1997, organization-based nursing interventions are now more often considered as potential solutions to poor quality and unsafe care. Organizational factors include nurse education, via preferential hiring practices and educational benefits to employees~ nurse staffing, an evolving "industry standard" that has been the focus of legislation~ human resource policies which determine nursing skill mix~ and the nursing work environment-the organizational practices fostering the autonomy and authority required for nurses to translate their education and experience into effective nursing care. In large, multi-state surveys of US nurses conducted in 1999 and in 2006, we have applied innovative sampling, aggregation, and measurement methods to provide rich information on nursing never before available for large numbers of healthcare organizations that is linked to patient outcomes to document the empirical relationship between nursing and outcomes. These data have been used to answer a range of compelling practice and policy questions about the contributions of nurses to safe, effective care. This application is an efficient, innovative extension of our line of research creating a large study of the impact of change in nursing factors on outcomes, seeking to determine more about causality in order to spur implementation of recommendations emerging from research. We will replicate in 2014 measurements made in 2006 (and 1999 in Pennsylvania) across approximately 665 hospitals and hundreds of nursing homes and home care agencies in four large states with measurement before and after the national economic downturn and the implementation of the Affordable Care Act. The great strength of the application is that in creating a panel of organizational observations, we can see where change has occurred and why. Specific aims are to: 1) Collect data from random samples of nurses in CA, FL, NJ, and PA~ 2) Examine organizational-level changes over time in nurse inputs in (a) education, (b) staffing, (c) skill mix, and (d) work environment between 1999, 2006, and 2014~ 3) Estimate the effects of organizational-level changes on outcomes for patients including minorities and those with chronic illnesses and determine whether lesser improvement in nursing resources in minority serving hospitals has widened the disparity in outcomes between white and minority patients~ and 4) Determine the effects of nursing factors in nursing home and home health agency patient outcomes while accounting for variation in patient clinical severity and complexity. The overarching aim of the proposed study is to determine points of comparatively low-cost organizational leverage of nursing inputs to improve patient outcomes.