J Nurs Adm. 2013 Oct;43(10 Suppl):S4-10. doi: 10.1097/01.NNA.0000435145.39337.d5.
Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why.
To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations.
Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences.
Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76–0.98; = 0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77–1.01; = 0.07) while controlling for nursing factors as well as hospital and patient differences.
The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes.
尽管有证据表明，以护理卓越而闻名的医院（磁铁医院）在吸引和留住护士方面非常成功，但尚不确定磁铁认证是否与非磁铁医院相比具有更好的患者结局，如果是，原因是什么。
确定磁铁医院的风险调整死亡率和抢救失败率是否低于非磁铁医院，并确定最可能的解释。
对 56 家磁铁医院和 508 家非磁铁医院的患者、护士和医院相关数据进行了关联分析。使用逻辑回归模型来估计在磁铁医院和非磁铁医院接受治疗的外科患者的死亡率和抢救失败率的差异，并确定在考虑患者和医院差异后，护理差异在多大程度上可以解释结局差异。
磁铁医院的工作环境明显更好，且拥有学士学位和专业认证的护士比例更高。这些护理因素解释了磁铁医院对患者结局影响的很大一部分原因。然而，在控制护理因素以及医院和患者差异后，在磁铁医院接受治疗的患者的死亡率降低了 14%（优势比 0.86；95%置信区间，0.76-0.98；P=0.02），抢救失败率降低了 12%（优势比 0.88；95%置信区间，0.77-1.01；P=0.07）。
我们在磁铁医院中发现的较低死亡率在很大程度上归因于可衡量的护理特征，但除此之外，磁铁认证还存在提高患者结局的优势。磁铁认证可以识别现有的质量优势，并激发进一步的积极组织行为，从而改善患者结局。
