Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology , Brisbane, Australia.
J Health Organ Manag. 2019 Mar 18;33(1):51-62. doi: 10.1108/JHOM-02-2018-0063. Epub 2018 Nov 16.
Nurse navigators (NNs) coordinate patient care, improve care quality and potentially reduce healthcare resource use. The purpose of this paper is to undertake an evaluation of hospitalisation outcomes in a new NN programme in Queensland, Australia.
DESIGN/METHODOLOGY/APPROACH: A matched case-control study was performed. Patients under the care of the NNs were randomly selected ( n=100) and were matched to historical ( n=300) and concurrent ( n=300) comparison groups. The key outcomes of interest were the number and types of hospitalisations, length of hospital stay and number of intensive care unit days. Generalised linear and two-part models were used to determine significant differences in resources across groups.
The control and NN groups were well matched on socio-economic characteristics, however, groups differed by major disease type and number/type of comorbidities. NN patients had high healthcare needs with 53 per cent having two comorbidities. In adjusted analyses, compared with the control groups, NN patients showed higher proportions of preventable hospitalisations over 12 months, similar days in intensive care and a smaller proportion had overnight stays in hospital. However, the NN patients had significantly more hospitalisations (mean: 6.0 for NN cases, 3.4 for historical group and 3.2 for concurrent group); and emergency visits.
RESEARCH LIMITATIONS/IMPLICATIONS: As many factors will affect hospitalisation rates beyond whether patients receive NN care, further research and longer follow-up is required.
ORIGINALITY/VALUE: A matched case-control study provides a reasonable but insufficient design to compare the NN and non-NN exposed patient outcomes.
护士导航员（NN）协调患者护理，提高护理质量，并有可能减少医疗资源的使用。本文旨在对澳大利亚昆士兰州一个新的 NN 计划的住院结果进行评估。
设计/方法/途径：进行了一项匹配病例对照研究。随机选择接受 NN 护理的患者（n=100），并与历史（n=300）和同期（n=300）对照组进行匹配。感兴趣的主要结果是住院次数和类型、住院时间和重症监护病房天数。使用广义线性和两部分模型来确定各组资源的显著差异。
控制组和 NN 组在社会经济特征上匹配良好，但在主要疾病类型和合并症的数量/类型上存在差异。NN 患者的医疗需求较高，有 53%的患者有两种合并症。在调整后的分析中，与对照组相比，NN 患者在 12 个月内有更高比例的可预防住院，在重症监护病房的天数相似，但住院过夜的比例较小。然而，NN 患者的住院次数明显更多（NN 病例的平均值为 6.0，历史组为 3.4，同期组为 3.2）；急诊就诊次数也更多。
研究局限性/影响：由于许多因素会影响住院率，超出了患者是否接受 NN 护理的影响，因此需要进一步的研究和更长时间的随访。
原创性/价值：匹配病例对照研究是一种合理但不充分的设计，可以比较 NN 和非 NN 暴露患者的结果。
