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磁性护理状况与全国质量指标下医院绩效的关联

Association of Magnet Nursing Status With Hospital Performance on Nationwide Quality Metrics.

作者信息

Boylan Matthew R, Suchman Kelly I, Korolikova Helen, Slover James D, Bosco Joseph A

出版信息

J Healthc Qual. 2019 Jul/Aug;41(4):189-194. doi: 10.1097/JHQ.0000000000000202.

Abstract

INTRODUCTION

Magnet Recognition is the highest distinction a healthcare organization can receive for excellence in nursing. Although Magnet status is generally associated with superior clinical outcomes and patient satisfaction, its association with performance on nationwide quality metrics is currently unknown.

METHODS

Within a propensity score-matched cohort, we compared performance on the Hospital-Acquired Condition Reduction Program (HACRP), Hospital Value-Based Purchasing (VBP), and Hospital Readmissions Reduction Program (RRP) initiatives.

RESULTS

The mean HACRP total performance score was inferior at Magnet versus non-Magnet hospitals (p < .001), and HACRP penalties were more likely to be levied against Magnet hospitals (p = .003). There was no significant difference according to Magnet status for VBP penalties after correcting for multiple comparisons (p = .049). There were no significant difference in RRP penalties according to Magnet status (p = .999).

CONCLUSIONS

Magnet hospitals performed worse on a number of hospitalwide quality metrics tied to reimbursement by the Centers for Medicare and Medicaid Service. Although Magnet hospitals are known for superior nursing care and organizational support for safety and quality improvement, this is not captured within these composite measures of quality, which can be influenced at many levels of care. These data underscore the need for comprehensive quality improvement across multiple domains of care outside of nursing.

LEVEL OF EVIDENCE

Level III, retrospective study.

摘要

引言

磁体认证是医疗机构在护理方面所能获得的最高荣誉。虽然磁体地位通常与卓越的临床结果和患者满意度相关,但其与全国质量指标表现之间的关联目前尚不清楚。

方法

在一个倾向评分匹配队列中,我们比较了医院获得性疾病减少计划(HACRP)、医院价值导向型采购(VBP)和医院再入院减少计划(RRP)举措的表现。

结果

磁体医院的HACRP总绩效得分低于非磁体医院(p <.001),并且磁体医院更有可能被征收HACRP罚款(p =.003)。在进行多重比较校正后,VBP罚款方面,磁体地位无显著差异(p =.049)。RRP罚款方面,磁体地位无显著差异(p =.999)。

结论

磁体医院在与医疗保险和医疗补助服务中心报销挂钩的多项全院质量指标上表现更差。虽然磁体医院以卓越的护理以及对安全和质量改进的组织支持而闻名,但在这些综合质量指标中并未体现,这些指标在多个护理层面都可能受到影响。这些数据强调了在护理之外的多个护理领域进行全面质量改进的必要性。

证据水平

III级,回顾性研究。

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