Rural Hospital Nursing: Environment, Effects and Evidence

乡村医院护理：环境、影响和证据

• 批准号: 7047363
• 负责人: ROBIN P NEWHOUSE
• 金额: $ 13.3万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-01-01 至 2008-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7047363
• 关键词: behavioral /social science research tag; clinical research; health care cost /financing; health care policy; health care service evaluation; health related legal; health services research tag; health surveys; hospital analysis; hospital organization /administration; human data; interview; nursing administration; nursing care evaluation; nursing care quality; nursing personnel; outcomes research; patient safety /medical error; rural health

DESCRIPTION (provided by applicant): Decreasing financial margins in rural hospitals and the potential impact on the quality of care are urgent concerns. Nursing care is directly related to quality, and is a basic essential core service for rural hospitals. The effects of legislative initiatives, service area and hospital characteristics on rural hospital nursing are unknown. The Agency for Healthcare Research and Quality and The Institute of Medicine have identified the rural population as a high priority for research. The overall objective of this proposed study is to evaluate the effects of legislative and market influences on rural nursing structure and patient outcomes. The specific aims are to: 1) Describe the impact of legislative changes and market influences on nursing in rural hospitals of various types; and 2) Examine the relationship between rural hospital nursing and patient outcomes. First, in a survey design, nurse executives (N=331) from rural hospitals for which quality outcomes are available will complete a telephone survey to describe the impact of legislative changes and market influences on nursing in rural hospitals. Second, nurse executive survey responses will be used in a cross-sectional correlational design to examine the impact of legislative changes and market influences on nursing in various types of rural hospitals. Third, a time-series design will be used to model changes over-time in financial margins on Registered Nurse Hours Per Patient Day (RNHPPD) and risk adjusted clinical outcomes [Health Care Utilization Project Quality Indicators (QIs) and Patient Safety Indicators (PSIs)], as well as the impact over time of RNHPPD on risk adjusted clinical outcomes (QIs and PSIs). Americans are faced with the dilemma of how to improve healthcare quality and safety, while creating a less wasteful and more efficient health system. This is an urgent priority for the rural population. This study has immediate significance for rural hospitals and rural hospital nursing through the identification of legislative initiatives, service area characteristics, hospital characteristics and nursing factors in rural hospitals that are related to quality of care. Study results will enable subsequent interventions to focus on improvement opportunities in rural hospitals. This project has promising potential to improve quality of care to the rural population using the novel approach of focusing on an understudied area, nursing in rural hospitals.

描述（由申请人提供）：乡村医院的财务利润下降以及对护理质量的潜在影响是迫切需要关注的问题。护理服务直接关系质量，是乡镇卫生院一项基本必备的核心服务。立法举措、服务区域和医院特色对乡村医院护理的影响尚不清楚。医疗保健研究与质量局和医学研究所已将农村人口确定为研究的重中之重。本研究的总体目标是评估立法和市场对农村护理结构和患者结果的影响。具体目标是： 1）描述立法变化和市场影响对各类乡村医院护理的影响； 2）考察乡村医院护理与患者预后之间的关系。首先，在调查设计中，来自可获得高质量结果的乡村医院的护士主管（N=331）将完成电话调查，以描述立法变化和市场对乡村医院护理的影响。其次，护士主管调查的答复将用于横断面相关设计，以检验立法变化和市场对各类乡村医院护理的影响。第三，时间序列设计将用于模拟每个患者每天的注册护士工作时间 (RNHPPD) 的财务利润随时间的变化以及风险调整后的临床结果 [医疗保健利用项目质量指标 (QI) 和患者安全指标 (PSI) )]，以及 RNHPPD 随着时间的推移对风险调整临床结果（QI 和 PSI）的影响。美国人面临着如何提高医疗质量和安全，同时创建一个更少浪费和更高效的医疗系统的困境。这是农村人口的当务之急。本研究通过识别与护理质量相关的乡村医院的立法举措、服务区域特征、医院特色和护理因素，对乡村医院和乡村医院护理具有直接意义。研究结果将使后续干预措施能够重点关注乡村医院的改进机会。该项目采用关注未充分研究领域（农村医院护理）的新方法，具有提高农村人口护理质量的巨大潜力。