Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA.
National Clinician Scholars Program, Yale University, New Haven, CT.
Med Care. 2024 May 1;62(5):288-295. doi: 10.1097/MLR.0000000000001966. Epub 2024 Apr 5.
To determine which hospital nursing resources (staffing, skill mix, nurse education, and nurse work environment) are most predictive of hospital Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) performance.
HCAHPS surveying is designed to quantify patient experience, a measure of patient-centered care. Hospitals are financially incentivized through the Centers for Medicare and Medicaid Services to achieve high HCAHPS ratings, but little is known about what modifiable hospital factors are associated with higher HCAHPS ratings.
Secondary analysis of multiple linked data sources in 2016 providing information on hospital HCAHPS ratings, hospital nursing resources, and other hospital attributes (eg, size, teaching, and technology status). Five hundred forty non-federal adult acute care hospitals in California, Florida, New Jersey, and Pennsylvania, and 11,786 registered nurses working in those hospitals. Predictor variables included staffing (ie, patient-to-nurse ratio), skill mix (ie, the proportion of registered nurses to all nursing staff), nurse education (ie, percentage of nurses with a bachelor's degree or higher), and nurse work environment (ie, the quality of the environment in which nurses work). HCAHPS ratings were the outcome variable.
More favorable staffing, higher proportions of bachelor-educated nurses, and better work environments were associated with higher HCAHPS ratings. The work environment had the largest association with higher HCAHPS ratings, followed by nurse education, and then staffing. Superior staffing and work environments were associated with higher odds of a hospital being a "higher HCAHPS performer" compared with peer hospitals.
Improving nursing resources is a strategic organizational intervention likely to improve HCAHPS ratings.
确定哪些医院护理资源（人员配置、技能组合、护士教育和护士工作环境）最能预测医院医院消费者评估医疗保健提供者和系统（HCAHPS）的表现。
HCAHPS 调查旨在量化患者体验，这是衡量以患者为中心的护理的一种措施。通过医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services），医院获得了经济激励，以实现高 HCAHPS 评级，但对于哪些可改变的医院因素与更高的 HCAHPS 评级相关知之甚少。
对 2016 年多个链接数据来源的二次分析，提供了有关医院 HCAHPS 评级、医院护理资源和其他医院特征（例如，规模、教学和技术地位）的信息。加利福尼亚州、佛罗里达州、新泽西州和宾夕法尼亚州的 540 家非联邦成人急性护理医院和在这些医院工作的 11786 名注册护士。预测变量包括人员配置（即，患者与护士的比例）、技能组合（即，注册护士与所有护理人员的比例）、护士教育（即，具有学士学位或更高学历的护士比例）和护士工作环境（即，护士工作环境的质量）。HCAHPS 评级是因变量。
更有利的人员配置、更高比例的具有学士学位的护士和更好的工作环境与更高的 HCAHPS 评级相关。工作环境与更高的 HCAHPS 评级关联最大，其次是护士教育，然后是人员配置。与同行医院相比，优越的人员配置和工作环境与医院成为“更高 HCAHPS 执行者”的可能性更高相关。
改善护理资源是一种战略组织干预措施，可能会提高 HCAHPS 评级。
