护士人员配备水平与急性护理服务质量：来自经合组织国家跨国面板数据分析的证据。
Nurse-staffing level and quality of acute care services: Evidence from cross-national panel data analysis in OECD countries.
作者信息
Amiri Arshia, Solankallio-Vahteri Tytti
机构信息
University of Eastern Finland, Kuopio, Finland.
JAMK University of Applied Sciences, Jyväskylä, Finland.
出版信息
Int J Nurs Sci. 2018 Dec 5;6(1):6-16. doi: 10.1016/j.ijnss.2018.11.010. eCollection 2019 Jan 10.
BACKGROUND
Most of previous studies aimed to estimate the effect of nurse staffing on quality of acute hospital care have used stochastic methods and their results are mixed.
OBJECTIVE
To measure the magnitude of effect of nurse-staffing level on increasing quality of acute care services in long-run.
DATA
The number of practicing nurses' density per 1000 population as the proxy of nurse-staffing level and three Health Care Quality Indicators (HCQI) included 30-day mortality per 100 patients based on acute myocardial infarction (MORTAMIO), hemorrhagic stroke (MORTHSTO) and ischemic stroke (MORTISTO) were collected as a part of ongoing project by OECD.org in panels of 26 OECD countries over 2005-2015 period.
METHOD
Panel data analysis.
RESULTS
There were committed relationships from nurse-staffing level to the enhancement of HCQI i.e. 1% increase in nurse-staffing level would reduce the rates of patient mortality based on MORTAMIO, MORTHSTO and MORTISTO by 0.65%, 0.60% and 0.80%, respectively. Furthermore, the role of nurse-staffing level in increasing overall HCQI were simulated at the highest level in Sweden (-3.53), Denmark (-3.31), Canada (-2.59), Netherlands (-2.33), Finland (-2.09), Switzerland (-1.72), Australia (-1.64) and United States (-1.53).
CONCLUSION
A higher proportion of nurses-staffing level is associated with higher quality of acute care services in OECD countries. Also, the nursing characteristics of Sweden, Denmark, Canada, Netherlands, Finland, Switzerland, Australia and United States would be good patterns for other countries to maximize nursing outcomes in the care of patients with acute and life-threatening conditions by reducing the risk of complication, mortality and adverse clinical outcomes.
背景
以往大多数旨在评估护士配备对急性医院护理质量影响的研究都采用了随机方法，其结果不一。
目的
从长期角度衡量护士配备水平对提高急性护理服务质量的影响程度。
数据
作为经合组织（OECD）组织正在进行的一个项目的一部分，收集了2005 - 2015年期间26个经合组织国家面板中每千人口执业护士密度作为护士配备水平的代理指标，以及三个医疗保健质量指标（HCQI），包括基于急性心肌梗死（MORTAMIO）、出血性中风（MORTHSTO）和缺血性中风（MORTISTO）的每100名患者30天死亡率。
方法
面板数据分析。
结果
护士配备水平与医疗保健质量指标的提升之间存在显著关系，即护士配备水平每提高1%，基于MORTAMIO、MORTHSTO和MORTISTO的患者死亡率分别降低0.65%、0.60%和0.80%。此外，在瑞典（-3.53）、丹麦（-3.31）、加拿大（-2.59）、荷兰（-2.33）、芬兰（-2.09）、瑞士（-1.72）、澳大利亚（-1.64）和美国（-1.53），护士配备水平对提高整体医疗保健质量指标的作用在最高水平上得到了模拟。
结论
在经合组织国家，较高比例的护士配备水平与较高质量的急性护理服务相关。此外，瑞典、丹麦、加拿大、荷兰、芬兰、瑞士、澳大利亚和美国的护理特点将是其他国家的良好模式，通过降低并发症、死亡率和不良临床结果的风险，在护理急性和危及生命的患者时最大限度地提高护理效果。
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