Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing.
Department of Sociology, Population Studies Center.
Med Care. 2018 Dec;56(12):1001-1008. doi: 10.1097/MLR.0000000000001002.
Evidence shows hospitals with better nursing resources have better outcomes but few studies have shown that outcomes change over time within hospitals as nursing resources change.
To determine whether changes in nursing resources over time within hospitals are related to changes in quality of care and patient safety.
Multilevel logistic response models, using data from a panel of 737 hospitals in which cross-sections of nurse informants surveyed in 2006 and 2016, were used to simultaneously estimate longitudinal and cross-sectional associations between nursing resources, quality of care, and patient safety.
Nursing resources included hospital-level measures of work environments, nurse staffing, and nurse education. Care quality was measured by overall rating of care quality, confidence in patients managing care after discharge, confidence in management resolving patient care problems; patient safety was measured by patient safety grade, concern with mistakes, and freedom to question authority.
After taking into account cross-sectional differences between hospitals, differences among nurses within hospitals, and potential confounding variables, changes within hospitals in nursing resources were associated with significant changes in quality of care and patient safety. Improvements in work environment of 1 SD decrease odds of unfavorable quality care and patient safety by factors ranging from 0.82 to 0.97.
Improvements within hospitals in work environments, nurse staffing, and educational composition of nurses coincide with improvements in quality of care and patient safety. Cross-sectional results closely approximate longitudinal panel results.
有证据表明，护理资源更好的医院会有更好的治疗效果，但很少有研究表明，随着护理资源的变化，医院内部的治疗效果会随时间发生变化。
确定医院内部护理资源随时间的变化是否与护理质量和患者安全的变化有关。
使用来自 737 家医院的面板数据，这些医院的护士信息员在 2006 年和 2016 年进行了横断面调查，使用多水平逻辑响应模型来同时估计护理资源、护理质量和患者安全之间的纵向和横断面关联。
护理资源包括医院层面的工作环境、护士人员配备和护士教育措施。护理质量通过对护理质量的总体评价、对患者出院后管理护理的信心、对管理解决患者护理问题的信心来衡量；患者安全通过患者安全等级、对失误的关注和质疑权威的自由来衡量。
在考虑到医院之间的横断面差异、医院内护士之间的差异以及潜在的混杂变量后，护理资源在医院内部的变化与护理质量和患者安全的显著变化相关。工作环境改善 1 个标准差，降低不良护理质量和患者安全的几率在 0.82 到 0.97 之间。
医院内部工作环境、护士人员配备和护士教育构成的改善与护理质量和患者安全的改善相一致。横断面结果与纵向面板结果非常接近。
