The Effect of High Inpatient Occupancy on Outcomes for Elderly Medicare Patients

高住院人数对老年医疗患者结果的影响

基本信息

批准号：
8701211
负责人：
Mahshid Abir
金额：
$ 21.76万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-15 至 2017-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8701211
关键词：
Accident and Emergency department Acute Admission activity Adult Adverse effects Affect Age-Years Area Arizona Benchmarking California Caring Charge Clinical Cohort Studies Crowding Data Data Set Development Elderly Failure Goals Health Health Services Accessibility Healthcare Systems Hospital Administrators Hospital Sizes Hospitals Inpatients Intervention Knowledge Laws Length of Stay Literature Masks Medical Medicare Methodology Mission National Institute on Aging Nature Nosocomial Infections Nurses Nursing Staff Outcome Patient Care Patients Policies Policy Maker Population Quality of Care Research Resources Statutes and Laws Testing Time United States National Institutes of Health Vulnerable Populations Work adverse outcome base clinical practice falls health care quality hospital occupancy improved mortality public health relevance response therapy development trend

项目摘要

DESCRIPTION (provided by applicant): Hospital crowding is a fundamental challenge confronting U.S. healthcare systems. Although it has been recognized as a problem in multiple aspects of patient care, most studies on crowding have focused on the emergency department (ED), showing increased mortality, reduced quality of care, and impaired access to care during periods of crowding. From the inpatient perspective, many studies showed the adverse effects of high patient-to-nurse ratios on outcomes. These and other studies were the basis for California (CA) legislation in 2004 requiring fixed patient-to-nurse ratios at all non-federal, acue care hospitals. Few studies have investigated the impact of this staffing benchmark on patient outcomes, showing mixed results. Also, only a few studies have examined the effect of a surge in admissions, high inpatient occupancy, and increased demand for resources on outcomes, demonstrating mixed results. Most of these studies have looked at the impact of high patient-to-nurse ratios and high hospital occupancy on outcomes for adults in general, which may mask the impact on medically vulnerable populations, including the elderly, who may be most sensitive to any adverse effects. The long-term goal of this work is to inform hospital administrators and policymakers about the potential adverse effects of hospitals operating at high occupancy levels to guide areas where interventions may be implemented to promote safer clinical practice, improved quality of care, and better patient outcomes for medically vulnerable populations. The overall objective, essential in attaining our long-term goal, is to fill the knowledge gap regarding the impact of high hospital occupancy on clinical outcomes for elderly Medicare patients. Our central hypothesis is that high occupancy produces adverse outcomes for elderly Medicare inpatients. We will use administrative hospital discharge data for the state of CA and Arizona (AZ) for 1998- 2011, including the 6 years before and 7 years after the implementation of state law in CA (2004) requiring fixed patient-to-nurse ratios. We will objectively test our central hypothesis through the following Specific Aim. Determine the impact of high hospital occupancy on outcomes for elderly Medicare inpatients. The underlying rationale for this proposal is that by identifying the subset of patients and outcomes that may be adversely affected by high occupancy, this study can have a positive impact by informing hospitals about targeted interventions aimed at improving outcomes for some of their most medically vulnerable inpatients.

描述（由申请人提供）：医院拥挤是面临美国医疗保健系统面临的基本挑战。尽管在患者护理的多个方面都被认为是一个问题，但大多数关于拥挤的研究都集中在急诊科（ED），表现出死亡率增加，护理质量的降低以及在拥挤期间获得医疗服务受损。从住院的角度来看，许多研究表明，高患者与核比率对结局的不利影响。这些研究和其他研究是2004年加利福尼亚（CA）立法的基础，要求所有非联邦，ACUE CARE医院固定的患者与糖比率。很少有研究研究该人员配备基准对患者预后的影响，显示出不同的结果。此外，只有少数研究研究了入院率激增，高住院医师入住率以及对资源对结果的需求增加的影响，这表明结果不同。这些研究中的大多数都研究了较高的患者与健康比率和高医院入住率对一般成年人的预后的影响，这可能掩盖对包括老年人在内的医学脆弱人群的影响，包括老年人，他们可能对任何不良反应最敏感。这项工作的长期目标是告知医院管理员和政策制定者，了解在高占用水平上运营的医院的潜在不利影响，以指导可能采取干预措施以促进更安全的临床实践，改善护理质量以及对医学脆弱人群的更好患者成果。实现我们的长期目标至关重要的总体目标是填补有关高医院入住对老年医疗保险患者临床结果的影响的知识差距。我们的中心假设是，高占用率对老年医疗保险住院患者产生不利结果。我们将在1998年至2011年使用CA和亚利桑那州（AZ）的行政医院出院数据，包括在CA（2004年）实施州法律之前的6年和7年之后，需要固定的患者与核心比率。我们将通过以下特定目标客观地测试中心假设。确定高医院入住对老年医疗保险住院患者预后的影响。该提案的根本理由是，通过确定患者的子集和可能受到高占用率影响的结果，这项研究可以通过向医院告知旨在改善其一些最易于医学脆弱的患者的目标干预措施来产生积极的影响。