Yakusheva Olga, Lindrooth Richard, Weiss Marianne
Division of Systems Leadership and Effectiveness Science, School of Nursing, Department of Health Management and Policy, School of Public Health, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482.
Health Serv Res. 2014 Dec;49(6):1767-86. doi: 10.1111/1475-6773.12236. Epub 2014 Sep 25.
The aims of the study were to (1) estimate the relative nurse effectiveness, or individual nurse value-added (NVA), to patients' clinical condition change during hospitalization; (2) examine nurse characteristics contributing to NVA; and (3) estimate the contribution of value-added nursing care to patient outcomes.
DATA SOURCES/STUDY SETTING: Electronic data on 1,203 staff nurses matched with 7,318 adult medical-surgical patients discharged between July 1, 2011 and December 31, 2011 from an urban Magnet-designated, 854-bed teaching hospital.
Retrospective observational longitudinal analysis using a covariate-adjustment value-added model with nurse fixed effects.
DATA COLLECTION/EXTRACTION METHODS: Data were extracted from the study hospital's electronic patient records and human resources databases.
Nurse effects were jointly significant and explained 7.9 percent of variance in patient clinical condition change during hospitalization. NVA was positively associated with having a baccalaureate degree or higher (0.55, p = .04) and expertise level (0.66, p = .03). NVA contributed to patient outcomes of shorter length of stay and lower costs.
Nurses differ in their value-added to patient outcomes. The ability to measure individual nurse relative value-added opens the possibility for development of performance metrics, performance-based rankings, and merit-based salary schemes to improve patient outcomes and reduce costs.
本研究的目的是：（1）评估护士的相对有效性，即个体护士的增加值（NVA）对患者住院期间临床状况变化的影响；（2）研究影响NVA的护士特征；（3）评估增值护理对患者结局的贡献。
数据来源/研究背景：关于1203名注册护士的电子数据，这些护士与2011年7月1日至2011年12月31日期间从一家拥有854张床位的城市指定磁石教学医院出院的7318名成年内科-外科患者相匹配。
采用带有护士固定效应的协变量调整增值模型进行回顾性观察纵向分析。
数据收集/提取方法：数据从研究医院的电子病历和人力资源数据库中提取。
护士效应具有联合显著性，解释了患者住院期间临床状况变化7.9%的方差。NVA与拥有学士学位或更高学位（0.55，p = 0.04）以及专业水平（0.66，p = 0.03）呈正相关。NVA有助于实现缩短住院时间和降低成本的患者结局。
护士对患者结局的增加值存在差异。衡量个体护士相对增加值的能力为制定绩效指标、基于绩效的排名和基于绩效的薪酬方案以改善患者结局和降低成本开辟了可能性。
