Analyzing Nurses' Impact on Outcomes Using Detailed Data

使用详细数据分析护士对结果的影响

• 批准号: 7095810
• 负责人: MARCELLINE RUTH HARRIS
• 金额: $ 29.67万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-01 至 2009-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7095810
• 关键词: allied health personnel; behavioral /social science research tag; clinical research; decubitus ulcer; health care personnel performance; health care service evaluation; health science manpower; health services research tag; hospital patient care; human data; human mortality; nurses; nursing care; nursing personnel; outcomes research; patient safety /medical error

DESCRIPTION (Provided by the Applicant): Reports by the IOM have focused national attention on the quality and safety of hospital care. There is increasing but inconsistent evidence of a relationship between hospital nurse staffing and adverse patient outcomes. Efforts to address both the current nursing shortage and to strategize around the much larger shortage projected have been hampered by these inconsistencies, and by gaps in the research evidence. This retrospective historical cohort study addresses these needs by taking advantage of 5-years (2000 - 2004) of the unique data resources of Mayo Clinic and its hospitals, which over the study period include data on 250,000 admissions, 1.5 million patient days, and 4.5 million patient shifts. There are three aims. First, at the patient level of detail, we analyze the frequency of adverse patient outcomes and test the relationship between these outcomes and the gap between targeted and actual hours of nursing care, as well as the mix of RNs, LPNS, and unlicensed patient care assistants and predict which patients are most likely to experience these outcomes. Second, at the unit-shift level of analysis, we test for relationships between the measures of nurse staffing identified above and adverse events that occur on a specific shift and unit. Third, we provide estimates of the incremental increases in total costs for patients who experience the adverse patient outcomes in aim 1. Importantly, we are able to risk adjust these outcomes. As a result, we believe we can determine: a) which patients are most at risk for experiencing a complication related to nurse staffing (both hours per patient day and staff mix), b) whether associations between adverse outcomes, adverse events, and nurse staffing are as strong as reported, and hence, whether they should be relied upon in surveillance systems for monitoring hospital quality; c) a new acuity adjustment metrics for use in analyzing nurse sensitive patient outcomes; and d) outcomes and their associated costs at discharge and within 30 days follow-up. Subsequently, this study can provide heretofore missing evidence needed to define nurse staffing levels associated with patient safety in U.S. hospitals.

描述（由申请人提供）：国际移民组织的报告引起了全国对医院护理质量和安全的关注。越来越多但不一致的证据表明医院护士人员配备与不良患者结果之间存在关系。这些不一致和研究证据的空白阻碍了解决当前护理短缺问题以及针对预计的更大规模护理短缺制定战略的努力。这项回顾性历史队列研究通过利用 Mayo Clinic 及其医院 5 年（2000 年 - 2004 年）的独特数据资源来满足这些需求，研究期间包括 250,000 例入院人数、150 万患者日和 4.5 个月的数据。百万患者轮班。有三个目标。首先，在患者细节层面，我们分析不良患者结果的频率，并测试这些结果与目标护理时间和实际护理时间之间的差距之间的关系，以及 RN、LPNS 和无证患者护理的组合助理并预测哪些患者最有可能经历这些结果。其次，在单位轮班分析层面，我们测试了上述护士人员配置措施与特定轮班和单位发生的不良事件之间的关系。第三，我们对经历目标 1 中不良结果的患者的总成本增量进行了估计。重要的是，我们能够对这些结果进行风险调整。因此，我们相信我们可以确定：a) 哪些患者最有可能出现与护士人员配备相关的并发症（每个患者每天的工作时间和人员组合），b) 不良结果、不良事件和护士之间是否存在关联人员配备与报道的一样强大，因此，监测系统是否应该依赖他们来监测医院质量； c) 新的敏锐度调整指标，用于分析护士敏感的患者结果； d) 出院时和 30 天内随访的结果及其相关费用。随后，这项研究可以提供迄今为止缺失的证据来定义与美国医院患者安全相关的护士人员配备水平。