Jette Diane U, Warren Reg L, Wirtalla Christopher
Department of Physical Therapy, Simmons College, Boston, Massachusetts 02115, USA.
Am J Phys Med Rehabil. 2004 Sep;83(9):704-12. doi: 10.1097/01.phm.0000137312.06545.d0.
To explore the relationship of patients' outcomes with nursing staff levels and therapy intensity within skilled nursing facilities.
Secondary analysis using administrative dataset of 6,897 patients from 68 skilled nursing facilities providing rehabilitation and reimbursed through Medicare+Choice. Independent measures were facility level nursing hours-to-resident ratio and total therapy hours per day. Outcomes included discharge to community and length of stay efficiency.
Patients were 1.53 times more likely to be discharged to the community when nursing staff level was > or = 3.5 hrs per resident per day as compared with <3.5, and patients were 1.22 and 2.02 times more likely to be discharged to the community when therapy averaged 1-1.5 hrs/day and >1.5 hrs/day, respectively, as compared with <1 hr/day. The adjusted mean length-of-stay efficiency was 0.21 points greater in facilities where the nursing staff level was > or = 3.5 hrs per resident per day than in facilities where the level was <3.5 and 0.43 and 0.70 points greater in facilities where patients received 1-1.5 hrs/day and >1.5 hrs/day of therapy, respectively, than in facilities where the average therapy intensity was <1 hr/day.
Higher nursing staff levels and therapy intensity are related to improved length-of-stay efficiency and increase the likelihood of patients' being discharged to the community.
探讨在专业护理机构中患者的治疗结果与护理人员水平及治疗强度之间的关系。
使用来自68家提供康复服务且通过“医疗保险 + 选择计划”报销的专业护理机构的6897名患者的管理数据集进行二次分析。独立指标为机构层面的护士与居民的工时比以及每天的总治疗时长。结果包括出院至社区以及住院时长效率。
与每天每名居民护理人员水平低于3.5小时相比，当护理人员水平≥3.5小时时，患者出院至社区的可能性高出1.53倍；与每天平均治疗时长低于1小时相比，当平均治疗时长为1 - 1.5小时/天和>1.5小时/天时，患者出院至社区的可能性分别高出1.22倍和2.02倍。调整后的平均住院时长效率在护理人员水平≥3.5小时/天的机构中比护理人员水平低于3.5小时/天的机构高0.21分，在患者接受1 - 1.5小时/天和>1.5小时/天治疗的机构中分别比平均治疗强度低于1小时/天的机构高0.43分和0.70分。
更高的护理人员水平和治疗强度与提高住院时长效率相关，并增加患者出院至社区的可能性。
