School ofAging Studies, University of South Florida, Tampa, Florida, USA.
J Aging Soc Policy. 2009 Oct-Dec;21(4):318-37. doi: 10.1080/08959420903166910.
Between 1999 and 2007, Florida implemented two initiatives combining legislative, regulatory, and reimbursement strategies to increase nurse staffing levels in nursing homes to improve quality of care. Despite a $40 million incentive package allocated for direct-care staffing, per-resident-day staffing increased only after legislative requirements mandated minimum nursing hours per resident day. Total Medicaid expenditures grew by $1.1 billion over the 8 years; per diem rates increased 65% to reimburse providers' costs. Registered nurses' hours decreased, while licensed nurses' and paraprofessionals' hours increased. This article describes the impact of staffing policy changes, includes stakeholders' views about approaches to achieve quality outcomes, and documents state policy implementation efforts. Seven lessons from the implementation of state nurse staffing standards to improve quality of care outcomes are also presented.
1999 年至 2007 年期间，佛罗里达州实施了两项计划，综合运用立法、监管和报销策略，以提高养老院的护士配备水平，从而改善护理质量。尽管分配了 4000 万美元的激励性薪酬用于直接护理人员配备，但只有在立法要求规定每位居民每天的最低护理时间之后，每位居民的日常护理人员配备才有所增加。在 8 年期间，医疗补助支出总额增长了 11 亿美元；日费率增长了 65%，以补偿提供者的成本。注册护士的工作时间减少，而持照护士和辅助人员的工作时间增加。本文介绍了人员配备政策变化的影响，包括利益相关者对实现质量成果的方法的看法，并记录了州政策实施工作。还提出了实施州护士人员配备标准以改善护理质量成果的七个经验教训。
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