Castle Nicholas G, Engberg John
Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
Health Serv Res. 2007 Oct;42(5):1822-47. doi: 10.1111/j.1475-6773.2007.00704.x.
The influence staffing levels, turnover, worker stability, and agency staff had on quality of care in nursing homes was examined.
DATA SOURCES/STUDY SETTING: Staffing characteristics came from a survey of nursing homes (N=1,071) conducted in 2003. The staffing characteristics were collected for Nurse Aides, Licensed Practical Nurses, and Registered Nurses. Fourteen quality indicators came from the Nursing Home Compare website report card and nursing home organizational characteristics came from the Online Survey, Certification, and Recording system.
One index of quality (the outcome) was created by combining the 14 quality indicators using exploratory factor analysis. We used regression analyses to assess the effect of the four staffing characteristics for each of the three types of nursing staff on this quality index in addition to individual analyses for each of the 14 quality indicators. The effect of organizational characteristics as well as the markets in which they operated on outcomes was examined. We examined a number of different model specifications.
Quality of care was influenced, to some degree, by all of these staffing characteristics. However, the estimated interaction effects indicated that achieving higher quality was dependent on having more than one favorable staffing characteristic--the effect of quality was larger than the sum of the independent effects of each favorable staffing characteristic.
Our results indicate that staff characteristics such as turnover, staffing levels, worker stability, and agency staff should be addressed simultaneously to improve the quality of nursing homes.
研究人员配备水平、人员流动率、员工稳定性及代理员工对养老院护理质量的影响。
数据来源/研究背景：人员配备特征数据来自于2003年对1071家养老院进行的一项调查。收集了护理助理、执业护士和注册护士的人员配备特征。14项质量指标来自养老院比较网站的成绩单，养老院组织特征来自在线调查、认证和记录系统。
通过探索性因素分析将14项质量指标合并，创建了一个质量指数（结果）。我们使用回归分析来评估三种类型护理人员各自的四项人员配备特征对该质量指数的影响，此外还对14项质量指标中的每一项进行了单独分析。研究了组织特征及其运营市场对结果的影响。我们考察了许多不同的模型规格。
所有这些人员配备特征在一定程度上都会影响护理质量。然而，估计的交互作用表明，要实现更高的质量，依赖于拥有不止一个有利的人员配备特征——质量的影响大于每个有利人员配备特征独立影响的总和。
我们的结果表明，应同时关注人员流动率、人员配备水平、员工稳定性及代理员工等人员特征，以提高养老院的护理质量。
