University of Southampton, United Kingdom.
Int J Nurs Stud. 2011 Oct;48(10):1199-210. doi: 10.1016/j.ijnurstu.2011.03.011. Epub 2011 May 14.
An association between quality of care and staffing levels, particularly registered nurses, has been established in acute hospitals. Recently an association between nurse staffing and quality of care for several chronic conditions has also been demonstrated for primary care in English general practice. A smaller body of literature identifies organisational factors, in particular issues of human resource management, as being a dominant factor. However the literature has tended to consider staffing and organisational factors separately.
We aim to determine whether relationships between the quality of clinical care and nurse staffing in general practice are attenuated or enhanced when organisational factors associated with quality of care are considered. We further aim to determine the relative contribution and interaction between these factors.
We used routinely collected data from 8409 English general practices. The data, on organisational factors and the quality of clinical care for a range of long term conditions, is gathered as part of "Quality and Outcomes Framework" pay for performance system. Regression models exploring the relationship of staffing and organisational factors with care quality were fitted using MPLUS statistical modelling software.
Higher levels of nurse staffing, clinical recording, education and reflection on the results of patient surveys were significantly associated with improved clinical care for COPD, CHD, Diabetes and Hypothyroidism after controlling for organisational factors. There was some evidence of attenuation of the estimated nurse staffing effect when organisational factors were considered, but this was small. The effect of staffing interacted significantly with the effect of organisational factors. Overall however, the characteristics that emerged as the strongest predictors of quality of clinical care were not staffing levels but the organisational factors of clinical recording, education and training and use of patient experience surveys.
Organisational factors contribute significantly to observed variation in the quality of care in English general practices. Levels of nurse staffing have an independent association with quality but also interact with organisational factors. The observed relationships are not necessarily causal but a causal relationship is plausible. The benefits and importance of education, training and personal development of nursing and other practice staff was clearly indicated.
在急症医院中，医疗服务质量与人员配备水平（尤其是注册护士）之间存在关联。最近，在英国普通科医生的初级保健中，也证明了护士人员配备与多种慢性病护理质量之间存在关联。较少的文献确定了组织因素（尤其是人力资源管理问题）是主要因素。但是，文献往往分别考虑人员配备和组织因素。
我们旨在确定在考虑与护理质量相关的组织因素时，一般实践中临床护理质量与护士人员配备之间的关系是否减弱或增强。我们进一步旨在确定这些因素之间的相对贡献和相互作用。
我们使用来自 8409 家英国普通诊所的常规收集数据。这些数据涉及组织因素以及一系列长期疾病的临床护理质量，是作为“质量和结果框架”绩效薪酬系统的一部分收集的。使用 MPLUS 统计建模软件拟合了探索人员配备和组织因素与护理质量之间关系的回归模型。
在控制了组织因素后，较高水平的护士人员配备、临床记录、教育和对患者调查结果的反思与 COPD、CHD、糖尿病和甲状腺功能减退症的临床护理改善显著相关。当考虑组织因素时，护士人员配备的估计效果会有所减弱，但幅度较小。人员配备的作用与组织因素的作用存在显著相互作用。但是，总体而言，作为临床护理质量最强预测因素的特征不是人员配备水平，而是组织因素，如临床记录、教育和培训以及患者体验调查的使用。
组织因素对英国普通诊所护理质量的观察到的变化有重要贡献。护士人员配备水平与质量之间存在独立关联，但也与组织因素相互作用。观察到的关系不一定是因果关系，但似是而非的。教育、培训和护理以及其他实践人员的个人发展的收益和重要性得到了明确的体现。
