医院护理特点对 30 天死亡率的影响。

The impact of hospital nursing characteristics on 30-day mortality.

机构信息

Faculty of Nursing; and Academic Codirector, Centre for Knowledge Transfer, Edmonton, Alberta, Canada.

出版信息

J Nurs Adm. 2011 Jul-Aug;41(7-8 Suppl):S58-68. doi: 10.1097/NNA.0b013e318221c260.

DOI:10.1097/NNA.0b013e318221c260

PMID:21799356

Abstract

BACKGROUND

Evidence indicates that hospital nursing characteristics such as staffing contribute to patient outcomes. Less attention has been given to other hospital nursing characteristics central to optimal professional practice, namely nurse education and skill mix, continuity of care, and quality of the work environment.

OBJECTIVE

To assess the relative effects and importance of nurse education and skill mix, continuity of care, and quality of work environment in predicting 30-day mortality after adjusting for institutional factors and individual patients characteristics.

METHOD

A cross-sectional analysis of outcome data for 18,142 patients discharged from 49 acute care hospitals in Alberta, Canada, for diagnoses of acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or stroke between April 1, 1998, and March 31, 1999, was done. Mortality data were linked to patient demographic and comorbidity factors, institutional characteristics, and hospital nursing characteristics derived from a survey of all registered nurses working in acute care hospitals.

RESULTS

Using multilevel analysis, it was determined that the log-odds for 30-day mortality varied significantly across hospitals (variance .044, p < .001). Patient comorbidities and age explained 44.2% of the variance in 30-day mortality. After adjustment for patient comorbidities and demographic factors, and the size, teaching, and urban status of the study hospitals in a fixed-effects model, the odds ratios (95% confidence interval) of the significant hospital nursing characteristics that predict 30-day mortality were as follows: 0.81 (0.68-0.96) for higher nurse education level, 0.83 (0.73-0.96) for richer nurse skill mix, 1.26 (1.09-1.47) for higher proportion of casual or temporary positions, and 0.74 (0.6-00.91) for greater nurse-physician relationships. The institutional and hospital nursing characteristics explained an additional 36.9%.

DISCUSSION

Hospital nursing characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients.

摘要

背景

有证据表明，医院护理特点（如人员配备）会影响患者的预后。然而，人们对其他与最佳专业实践相关的重要医院护理特点（如护士教育和技能组合、护理连续性以及工作环境质量）关注较少。

目的

评估护士教育和技能组合、护理连续性以及工作环境质量在调整机构因素和患者个体特征后对 30 天死亡率的相对影响和重要性。

方法

对 1998 年 4 月 1 日至 1999 年 3 月 31 日期间，在加拿大艾伯塔省 49 家急性护理医院因急性心肌梗死、充血性心力衰竭、慢性阻塞性肺疾病、肺炎或中风出院的 18142 名患者的结局数据进行了横断面分析。通过对在急性护理医院工作的所有注册护士进行的调查，将死亡率数据与患者人口统计学和合并症因素、机构特征以及医院护理特征联系起来。

结果

通过多水平分析，确定 30 天死亡率在医院间差异显著（方差.044，p<.001）。患者合并症和年龄解释了 30 天死亡率 44.2%的差异。在固定效应模型中，调整患者合并症和人口统计学因素以及研究医院的规模、教学和城市地位后，预测 30 天死亡率的显著医院护理特征的优势比（95%置信区间）如下：护士教育水平较高（0.81，0.68-0.96）、护士技能组合较丰富（0.83，0.73-0.96）、临时或兼职人员比例较高（1.26，1.09-1.47）、护士与医生关系较好（0.74，0.6-0.91）。机构和医院护理特征解释了另外的 36.9%。