Department of Systems, Populations, and Leadership, School of Nursing & Department of Health Management and Policy, School of Public Health, Ann Arbor, MI.
Marquette University College of Nursing, Milwaukee, WI.
Med Care. 2019 Sep;57(9):688-694. doi: 10.1097/MLR.0000000000001170.
Applied to value-based health care, the economic term "individual productivity" refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient's likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits].
Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics.
A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016.
Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return.
Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (-0.48 absolute percentage points, P<0.001) and an ED visit (-0.29 absolute percentage points, P=0.042).
Variability in individual clinician productivity can have implications for acute care quality patient outcomes.
在基于价值的医疗保健中，经济术语“个体生产力”是指通过护理过程归因于个体临床医生的结果质量。本研究旨在：（1）估计和描述个体急症护理护士的出院准备生产力；（2）研究出院护士的出院准备生产力与患者 30 天内再次住院[再入院和急诊就诊（ED）]的可能性之间的关联。
对患者出院准备度和再入院情况的多站点集群随机研究的患者-护士数据进行二次分析。患者报告出院准备得分；出院后结局和其他变量从电子健康记录中提取。使用结构-过程-结果模型，我们将患者出院准备视为出院准备过程的近端结局，并将其用于衡量护士在出院准备方面的生产力。我们将医院返回视为对出院准备护理敏感的远端结局。多水平回归分析采用了拆分样本方法，并调整了患者特征。
共有 522 名护士和 29986 名成年（18 岁及以上）患者，于 2015 年 6 月 15 日至 2016 年 11 月 30 日从 31 个地理位置不同的内科-外科病房出院回家。
使用 8 项简短的医院出院准备量表（RHDS）评估患者出院准备情况。30 天内医院返回是一个分类变量，包括再入院或 ED 就诊，而非无医院返回。
个体护士生产力的变异性解释了患者出院准备得分的 9.07%的差异。护士的生产力与再入院的可能性呈负相关（-0.48 个百分点，P<0.001）和 ED 就诊（-0.29 个百分点，P=0.042）。
个体临床医生生产力的变异性可能对急性护理质量和患者结局产生影响。
