Panel Study of Effects of Changes in Nursing on Patient Outcomes

描述（由申请人提供）：护理变化对患者预后影响的小组研究。护理的组织和实践对患者护理和患者预后有实质性的积极影响。自1997年以来，由于我们的nnr赞助的研究项目不断得到资助，基于组织的护理干预现在更常被认为是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，通过优先雇用实践和员工的教育福利，护士人员配置，一个不断发展的“行业标准”，一直是立法的焦点，人力资源政策，决定护理技能组合和护理工作环境，组织实践培养自主权和权威，需要护士将他们的教育和经验转化为有效的护理。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，为大量与患者结果相关的医疗保健组织提供了前所未有的丰富护理信息，以记录护理与结果之间的经验关系。这些数据已被用来回答关于护士对安全、有效护理的贡献的一系列令人信服的实践和政策问题。本应用程序是我们的研究线的一个有效的，创新的延伸，创建了护理因素变化对结果的影响的大型研究，试图确定更多的因果关系，以促进实施从研究中提出的建议。我们将在2014年复制2006年（和1999年在宾夕法尼亚州）在四个大州的大约665家医院和数百家养老院和家庭护理机构中进行的测量，并在国家经济衰退和实施平价医疗法案之前和之后进行测量。该应用程序的强大之处在于，在创建组织观察面板时，我们可以看到发生更改的位置和原因。具体目标是：1)从CA， FL， NJ和PA的护士随机样本中收集数据~ 2)检查1999年至2006年间护士在(a)教育，(b)人员配置，(c)技能组合和(d)工作环境方面的投入随时间的组织层面变化；3)评估组织层面的变化对包括少数民族和慢性病患者在内的患者结局的影响，并确定少数民族服务医院护理资源的改善是否扩大了白人和少数民族患者结局的差异；4)在考虑患者临床严重程度和复杂性的变化的情况下，确定养老院和家庭健康机构患者结局的护理因素的影响。拟议研究的总体目标是确定护理投入相对低成本的组织杠杆点，以改善患者的预后。

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.