The Wharton School, University of Pennsylvania, Philadelphia, PA 19104, USA.
New York University School of Medicine, New York, NY 10016, USA.
J Health Econ. 2018 May;59:26-45. doi: 10.1016/j.jhealeco.2018.03.003. Epub 2018 Mar 27.
Effective workforce assignment has the potential for improving performance. Using novel home health data combining provider work logs, personnel data, and detailed patient records, we estimate the effect of provider handoffs-a marker of care discontinuity-on hospital readmissions, an important performance measure for healthcare systems. We use workflow interruption caused by attrition and providers' work inactivity as an instrument for nurse handoffs. We find handoffs to substantially increase hospital readmissions. Our estimates imply that a single handoff increases the likelihood of 30-day hospital readmission by 16 percent and one in four hospitalizations during home health care would be avoided if handoffs were eliminated. Moreover, handoffs are more detrimental for high-severity patients and expedite hospital readmission. The frequency and sequencing of handoffs also affect the likelihood of rehospitalization.
有效的劳动力分配有可能提高绩效。我们利用新颖的家庭保健数据，结合提供商工作记录、人员数据和详细的患者记录，来评估提供方交接（护理中断的标志）对医院再入院的影响，这是医疗保健系统的一个重要绩效衡量标准。我们使用人员流失造成的工作流程中断和提供商的无工作状态作为护士交接的工具。我们发现交接会大大增加医院的再入院率。我们的估计表明，一次交接会使 30 天内医院再入院的可能性增加 16%，如果消除交接，四分之一的家庭保健住院治疗将可以避免。此外，交接对高严重程度的患者更不利，并会加速医院的再入院。交接的频率和顺序也会影响再次住院的可能性。
