Martsolf Grant R, Auerbach David, Benevent Richele, Stocks Carol, Jiang H Joanna, Pearson Marjorie L, Ehrlich Emily D, Gibson Teresa B
*RAND Corporation, Pittsburgh, PA †Formerly of RAND Corporation, Boston, MA ‡Truven Health Analytics, Santa Barbara, CA §Agency for Healthcare Research and Quality (AHRQ) Center for Delivery, Organization, and Markets (CDOM), Rockville, MD ∥RAND Corporation, Santa Monica, CA ¶Truven Health Analytics, Ann Arbor, MI.
Med Care. 2014 Nov;52(11):982-8. doi: 10.1097/MLR.0000000000000248.
Inpatient quality deficits have important implications for the health and well-being of patients. They also have important financial implications for payers and hospitals by leading to longer lengths of stay and higher intensity of treatment. Many of these costly quality deficits are particularly sensitive to nursing care.
To assess the effect of nurse staffing on quality of care and inpatient care costs.
Longitudinal analysis using hospital nurse staffing data and the Healthcare Cost and Utilization Project State Inpatient Databases from 2008 through 2011.
Hospital discharges from California, Nevada, and Maryland (n=18,474,860).
A longitudinal, hospital-fixed effect model was estimated to assess the effect of nurse staffing levels and skill mix on patient care costs, length of stay, and adverse events, adjusting for patient clinical and demographic characteristics.
Increases in nurse staffing levels were associated with reductions in nursing-sensitive adverse events and length of stay, but did not lead to increases in patient care costs. Changing skill mix by increasing the number of registered nurses, as a proportion of licensed nursing staff, led to reductions in costs.
The study findings provide support for the value of inpatient nurse staffing as it contributes to improvements in inpatient care; increases in staff number and skill mix can lead to improved quality and reduced length of stay at no additional cost.
住院患者的质量缺陷对患者的健康和福祉具有重要影响。这些缺陷还会因住院时间延长和治疗强度增加，给支付方和医院带来重大经济影响。其中许多代价高昂的质量缺陷对护理工作尤为敏感。
评估护士配备对护理质量和住院护理成本的影响。
利用2008年至2011年的医院护士配备数据以及医疗成本与利用项目州住院数据库进行纵向分析。
加利福尼亚州、内华达州和马里兰州的医院出院病例（n = 18474860）。
估计一个纵向的医院固定效应模型，以评估护士配备水平和技能组合对患者护理成本、住院时间和不良事件的影响，并对患者的临床和人口统计学特征进行调整。
护士配备水平的提高与护理敏感型不良事件的减少和住院时间的缩短相关，但并未导致患者护理成本增加。通过增加注册护士在持牌护理人员中的比例来改变技能组合，可降低成本。
研究结果支持住院护士配备的价值，因为它有助于改善住院护理；增加护士数量和技能组合可在不增加成本的情况下提高护理质量并缩短住院时间。
