Department of Economics, Farmer School of Business, Miami University, 800 E. High Street, Oxford, OH 45056, USA.
Health Serv Res. 2011 Oct;46(5):1495-516. doi: 10.1111/j.1475-6773.2011.01274.x. Epub 2011 May 24.
To study the impact of minimum direct care staffing (MDCS) requirements on nurse staffing levels, nurse skill mix, and quality.
U.S. nursing home facility data from the Online Survey Certification and Reporting (OSCAR) System merged with MDCS requirements. STUDY DESIGN; Facility-level outcomes of nurse staffing levels, nurse skill mix, and quality measures are regressed on the level of nurse staffing required by MDCS requirements in the prior year and other controls using fixed effect panel regression. Quality measures are care practices, resident outcomes, and regulatory deficiencies.
Analysis used all OSCAR surveys from 1999 to 2004, resulting in 17,552 unique facilities with a total of 94,371 survey observations.
The effect of MDCS requirements varied with reliance of the nursing home on Medicaid. Higher MDCS requirements increase nurse staffing levels, while their effect on nurse skill mix depends on the reliance of the nursing home on Medicaid. MDCS have mixed effects on care practices but are generally associated with improved resident outcomes and meeting regulatory standards.
MDCS requirements change staffing levels and skill mix, improve certain aspects of quality, but can also lead to use of care practices associated with lower quality.
研究最低直接护理人员配置（MDCS）要求对护士人员配置水平、护士技能组合和质量的影响。
美国养老院设施数据来自在线调查认证和报告（OSCAR）系统，与 MDCS 要求在前一年所需的护士人员配置水平合并。使用固定效应面板回归，对护士人员配置水平、护士技能组合和质量措施的设施水平结果进行回归，同时控制其他因素。质量措施是护理实践、居民结果和监管缺陷。
分析使用了 1999 年至 2004 年的所有 OSCAR 调查，共有 17552 个独特的设施，共有 94371 个调查观察。
MDCS 要求的影响因养老院对医疗补助的依赖程度而异。较高的 MDCS 要求增加了护士人员配置水平，而其对护士技能组合的影响取决于养老院对医疗补助的依赖程度。MDCS 对护理实践有混合影响，但通常与改善居民结果和符合监管标准有关。
MDCS 要求改变了人员配置水平和技能组合，提高了质量的某些方面，但也可能导致使用与较低质量相关的护理实践。
