Division of Scientific Education and Professional Development, The U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
Health Serv Res. 2020 Jun;55(3):375-382. doi: 10.1111/1475-6773.13273. Epub 2020 Feb 13.
To examine the associations between Medicaid expansion and nurse staffing ratios and hospital-wide readmission rates.
Secondary data from the 2011-2016 Healthcare Cost Report Information System, the American Hospital Association Annual Survey, and the Hospital Compare data.
Difference-in-difference models are used to compare outcomes in hospitals located in states that expanded Medicaid with those located in nonexpansion states. The changes in nurse staffing ratios and hospital-wide readmission rates are calculated in each one of the postexpansion years (2014, 2015, and 2016), compared to pre-expansion.
Results indicate that nurse staffing ratios increased, whereas hospital-wide readmission rates declined in expansion states relative to nonexpansion states. Nurse staffing ratios increased by 0.33, 0.42, and 0.46 registered nurses hours per adjusted patient days in 2014, 2015, and 2016 in hospitals located in expansion states, compared with hospitals in nonexpansion states after expansion. This increase was statistically significant (P < .001) in 2015 and 2016, but marginally significant (P = .016) in 2014. Hospital-wide readmission rates statistically significantly decreased by 9, 16, and 18 per 10 000 patients (P < .001) in 2014, 2015, and 2016, respectively, in expansion vs nonexpansion states hospitals after expansion.
Medicaid expansion was associated with gradually improved hospitals' nurse staffing ratios and hospital-wide readmission rates from 2014 through 2016. The continued monitoring of quality measures of hospitals can help assess the impact of Medicaid expansion over a longer period of time.
考察医疗补助计划扩围与护士人员配备比率和医院整体再入院率之间的关联。
2011-2016 年医疗保健成本报告信息系统、美国医院协会年度调查和医院比较数据的二级数据。
使用差异中的差异模型比较位于医疗补助计划扩围州的医院与位于非扩围州的医院的结果。在每个扩围后年份（2014 年、2015 年和 2016 年），计算护士人员配备比率和医院整体再入院率的变化，与扩围前相比。
结果表明，与非扩围州相比，扩围州的护士人员配备比率增加，而医院整体再入院率下降。在扩围州的医院，与扩围前相比，2014 年、2015 年和 2016 年每调整患者住院日的注册护士工时分别增加了 0.33、0.42 和 0.46，这一增加在 2015 年和 2016 年具有统计学意义（P<.001），但在 2014 年仅具有边缘统计学意义（P=.016）。在扩围州的医院，医院整体再入院率分别在 2014 年、2015 年和 2016 年每 10000 名患者中下降了 9、16 和 18，与非扩围州的医院相比，差异具有统计学意义（P<.001）。
从 2014 年到 2016 年，医疗补助计划扩围与医院护士人员配备比率和医院整体再入院率的逐渐改善相关。对医院质量指标的持续监测有助于在更长的时间内评估医疗补助计划扩围的影响。
