Department of Nursing, Birmingham City University, Birmingham, UK.
Independent Consultant, Athens, Greece.
Int Nurs Rev. 2017 Sep;64(3):345-352. doi: 10.1111/inr.12380. Epub 2017 Jun 9.
To test the effect on patient mortality of implementing a nursing systems framework across a national health system.
There have been five previous observational studies that have tested the effect of a nursing systems framework on clinical outcomes for patients. Implementation of a nursing systems framework in the health system of a developing country has not been evaluated.
Quasi-experimental (before and after) study.
A nursing systems framework consisting of six themes: (i) Professionalisation; (ii) Education; (iii) Structure; (iv) Quality of nursing care; (v) An academic health system; and (vi) Communication (Professional), was implemented across the national health system of Qatar in March 2015. Routine administrative data were extracted (March 2014-February 2016) for elective admissions. Our primary and secondary outcomes were, respectively, all cause mortality at discharge and readmission to hospital (within 28 days of discharge). We split the data into two time periods: before (March 2014-February 2015) and after (March 2015-February 2016) the implementation of the nursing systems framework. Multivariable regression modelling was used to examine the effect of the framework on patient mortality, after adjusting for key confounding variables (patient age, episode acuity, intensive care admission and length of stay).
Data were extracted for 318 548 patients (year 1 = 130 829; year 2 = 187 725). After adjusting for confounding, there was a significant association between the implementation of the nursing systems framework, mortality and readmission.
Our observations suggest that the implementation of a nursing systems framework may be important in improving outcomes for patients in emerging health systems.
检验在国家卫生系统中实施护理系统框架对患者死亡率的影响。
此前已有五项观察性研究检验了护理系统框架对患者临床结局的影响。在发展中国家的卫生系统中实施护理系统框架尚未得到评估。
准实验（前后）研究。
2015 年 3 月，在卡塔尔国家卫生系统中实施了一个由六个主题组成的护理系统框架：（i）专业化；（ii）教育；（iii）结构；（iv）护理质量；（v）学术卫生系统；和（vi）沟通（专业）。从 2014 年 3 月至 2016 年 2 月提取了择期入院的常规行政数据。我们的主要和次要结局分别是出院时的全因死亡率和（出院后 28 天内）再次入院。我们将数据分为两个时间段：实施护理系统框架之前（2014 年 3 月至 2015 年 2 月）和之后（2015 年 3 月至 2016 年 2 月）。使用多变量回归模型，在调整了关键混杂变量（患者年龄、发病严重程度、入住重症监护病房和住院时间）后，检验了框架对患者死亡率的影响。
共提取了 318548 名患者的数据（第 1 年=130829 人；第 2 年=187725 人）。在调整了混杂因素后，实施护理系统框架与死亡率和再入院之间存在显著关联。
我们的观察结果表明，在新兴卫生系统中，实施护理系统框架可能对改善患者结局至关重要。
