Needleman Jack
Department of Health Services, University of California, Los Angeles School of Public Health, CA, USA.
Policy Polit Nurs Pract. 2008 May;9(2):80-7. doi: 10.1177/1527154408320047.
This article examines the social and business case for quality related to nursing and the need to restructure incentives to align the interests of the hospital and payers with the interests of the patients. Increasing the proportion of nurses who are registered nurses is associated with net cost savings. Increasing both nursing hours and the proportion of nurses who are registered nurses would result in improved quality and fewer deaths (creating a social case for improved staffing) but would be associated with small cost increases. Cost offsets associated with reduced turnover because of higher staffing would reduce the net cost increase but not result in savings. Under current reimbursement systems, hospitals that increase nurse staffing to improve patient outcomes will likely lose money as a result. Current proposals for pay for performance would create limited incentives for improving hospital nursing care.
本文探讨了与护理质量相关的社会和商业案例，以及调整激励措施以使医院和付款方的利益与患者利益保持一致的必要性。增加注册护士在护士中的比例与净成本节约相关。增加护理时长以及注册护士在护士中的比例，将提高护理质量并减少死亡人数（这为改善人员配备提供了社会依据），但成本会有小幅增加。因人员配备增加导致人员流动减少所带来的成本抵消，将减少净成本增加，但不会带来节约。在当前的报销体系下，那些为改善患者预后而增加护士配备的医院可能会因此亏损。当前的绩效薪酬提案对改善医院护理的激励作用有限。
