*Division of Systems Leadership and Effectiveness Science, School of Nursing, Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI †Department of Health Systems, Management and Policy, School of Public Health, University of Colorado, Aurora, CO ‡College of Nursing, Marquette University, Milwaukee, WI.
Med Care. 2014 Oct;52(10):864-9. doi: 10.1097/MLR.0000000000000189.
Higher proportions of BSN-educated nurses were associated with improved outcomes in hospital-level studies. A recent Institute of Medicine report calls for increasing the proportion of BSN-educated nurses to 80% by 2020. Patient-level evidence of cost and quality implications of the 80% BSN threshold is needed for a business case to support these efforts.
To conduct the economic analysis of meeting the 80% BSN threshold on patient outcomes and costs, using linked patient-nurse data.
Retrospective observational patient-level analysis of electronic data. Linear and logistic regression modeling with patient controls and diagnosis and unit fixed effects.
A total of 8526 adult medical-surgical patients matched with 1477 direct care nurses from an Eastern US academic medical center, during June 1, 2011-December 31, 2011.
Outcomes include hospital mortality, all-cause same-facility 30-day readmission, length-of-stay, and total hospitalization cost. BSN proportion is a continuous measure for the proportion of nurse assessment inputs into the patient's electronic medical record made by BSN-educated nurses; a dichotomous indicator for BSN proportion is 0.8-1.0.
Continuous BSN proportion was associated with lower mortality (OR=0.891, P<0.01). Compared with patients with <80% BSN care, patients receiving ≥ 80% of care from BSN nurses had lower odds of readmission (OR=0.813, P=0.04) and 1.9% shorter length-of-stay (P=0.03). Economic simulations support a strong business case for increasing the proportion of BSN-educated nurses to 80%.
A combined approach of increasing the hospital-level BSN proportion to 80% and assuring a high BSN dose through individual patient-level staffing assignments is needed to achieve projected quality and costs benefits.
在医院层面的研究中，拥有更高比例的 BSN 教育护士与改善结果相关。最近的一份美国国家医学研究院报告呼吁到 2020 年将 BSN 教育护士的比例提高到 80%。为了支持这些努力，需要有关于 80%BSN 门槛对患者成本和质量影响的患者层面的证据，以建立一个商业案例。
利用患者-护士数据，对达到 80%BSN 门槛对患者结果和成本的经济分析进行研究。
回顾性观察性患者层面的电子数据分析。使用患者对照和诊断及单位固定效应的线性和逻辑回归模型。
2011 年 6 月 1 日至 2011 年 12 月 31 日，来自美国东部一所学术医疗中心的 8526 名成年内科-外科患者与 1477 名直接护理护士相匹配。
结果包括医院死亡率、全因同一机构 30 天再入院、住院时间和总住院费用。BSN 比例是一个连续变量，用于衡量 BSN 教育护士在患者电子病历中的护士评估输入比例；BSN 比例的二分指标为 0.8-1.0。
连续 BSN 比例与较低的死亡率相关（OR=0.891，P<0.01）。与接受<80%BSN 护理的患者相比，接受≥80%BSN 护士护理的患者再入院的可能性较低（OR=0.813，P=0.04），住院时间缩短 1.9%（P=0.03）。经济模拟支持了将 BSN 教育护士的比例提高到 80%的强有力的商业案例。
需要采取综合方法，将医院层面的 BSN 比例提高到 80%，并通过患者层面的人员配置任务确保高 BSN 剂量，以实现预期的质量和成本效益。
