Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System, Seattle, WA, USA.
Med Care. 2011 Aug;49(8):708-15. doi: 10.1097/MLR.0b013e318223a9f1.
Studies suggest that a business case for improving nurse staffing can be made to increase registered nurse (RN) skill mix without changing total licensed nursing hours. It is unclear whether a business case for increasing RN skill mix can be justified equally among patients of varying health needs. This study evaluated whether nursing hours per patient day (HPPD) and skill mix are associated with higher inpatient care costs within acute medical/surgical inpatient units using data from the Veterans Health Administration.
Retrospective cross-sectional study, including 139,360 inpatient admissions to 292 acute medical/surgical units at 125 Veterans Health Administration medical centers between February and June 2003, was conducted. Dependent variables were inpatient costs per admission and costs per patient day.
The average costs per surgical and medical admission were $18,624 and $6,636, respectively. Costs per admission were positively associated with total nursing HPPD among medical admissions ($164.49 per additional HPPD, P<0.001), but not among surgical admissions. Total nursing HPPD and RN skill mix were associated with higher costs per hospital day for both medical admissions ($79.02 per additional HPPD and $5.64 per 1% point increase in nursing skill mix, both P<0.001) and surgical admissions ($112.47 per additional HPPD and $13.31 per 1% point increase in nursing skill mix, both P<0.001). Patients experiencing complications or transferring to an intensive care unit had higher inpatient costs than other patients.
The association of nurse staffing level with costs per admission differed for medical versus surgical admissions.
有研究表明，在不改变注册护士总工作时间的情况下，通过提高护士技能组合，可以为改善护士人力配置提供商业案例。目前尚不清楚在不同健康需求的患者中，提高护士技能组合的商业案例是否同样合理。本研究使用退伍军人健康管理局的数据，评估了每患者住院日（HPPD）和技能组合与急性内科/外科住院病房内住院患者更高的护理费用之间的关系。
这是一项回顾性的横截面研究，共纳入了 2003 年 2 月至 6 月期间退伍军人健康管理局 125 个医疗中心的 292 个内科/外科急性病房 139360 例住院患者。因变量为每次住院的费用和每天每位患者的费用。
手术和内科住院的平均费用分别为 18624 美元和 6636 美元。内科住院的每次住院费用与总护理 HPPD 呈正相关（每增加 1 个 HPPD 增加 164.49 美元，P<0.001），但与外科住院无关。总护理 HPPD 和护士技能组合与内科和外科住院的每日住院费用均相关（每增加 1 个 HPPD 分别增加 79.02 美元和 5.64 美元，每增加 1%的护士技能组合分别增加 112.47 美元和 13.31 美元，均 P<0.001）。发生并发症或转入重症监护病房的患者的住院费用高于其他患者。
护士人员配置水平与内科和外科住院的每次住院费用之间的关系不同。
