Department of Health Care Management, Universität Hamburg, Hamburg, Germany.
Hamburg Center for Health Economics (HCHE), Hamburg, Germany.
Health Serv Res. 2018 Jun;53(3):1799-1818. doi: 10.1111/1475-6773.12756. Epub 2017 Aug 14.
To examine the relationship between nurse staffing patterns and patients' experience of care in hospitals with a particular focus on staffing flexibility.
DATA SOURCES/STUDY SETTING: The study sample comprised U.S. general hospitals between 2010 and 2012. Nurse staffing data came from the American Hospital Association Annual Survey, and patient experience data came from the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems.
An observational research design was used entailing a pooled, cross-sectional data set. Regression models were estimated using generalized estimating equation (GEE) and hospital fixed effects. Nurse staffing patterns were assessed based on both levels (i.e., ratio of full-time equivalent nurses per 1,000 patient days) and composition (i.e., skill mix-percentage of registered nurses; staffing flexibility-percentage of part-time nurses).
All three staffing variables were significantly associated with patient experience in the GEE analysis, but only staffing flexibility was significant in the fixed-effects analysis. A higher percentage of part-time nurses was positively associated with patient experience. Multiplicative and nonlinear effects for the staffing variables were also observed.
Among three staffing variables, flexibility was found to be the most important relative to patient experience. Unobserved hospital characteristics appear to underlie patient experience as well as certain nurse staffing patterns.
研究护士配置模式与医院患者护理体验之间的关系，特别关注配置的灵活性。
数据来源/研究环境：研究样本包括 2010 年至 2012 年间的美国综合医院。护士人员配置数据来自美国医院协会年度调查，患者体验数据来自医疗保险医院医疗保健提供者和系统评估。
采用观察性研究设计，包括一个汇总的、横截面数据集。使用广义估计方程（GEE）和医院固定效应估计回归模型。护士人员配置模式基于水平（即每 1000 个患者天的全职当量护士比例）和组成（即注册护士的技能组合百分比；配置灵活性-兼职护士的百分比）进行评估。
在 GEE 分析中，所有三个人员配置变量与患者体验显著相关，但只有人员配置灵活性在固定效应分析中具有显著意义。兼职护士的比例越高，与患者体验呈正相关。还观察到人员配置变量的乘法和非线性效应。
在三个人员配置变量中，灵活性相对于患者体验被认为是最重要的。未观察到的医院特征似乎是患者体验以及某些护士人员配置模式的基础。
