Fabrizi Diletta, Bernasconi Davide Paolo, Locatelli Giulia, Luciani Michela, Beretta Giorgio, Di Mauro Stefania, Rebora Paola, Ausili Davide
Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Italy.
Bicocca Bioinformatics Biostatistics and Bioimaging (B4) Centre, School of Medicine and Surgery, University of Milano-Bicocca, Via Follereau 3, 20854 Vedano al Lambro, Italy.
Healthcare (Basel). 2024 Oct 5;12(19):1988. doi: 10.3390/healthcare12191988.
In Italy, Diagnosis-Related Groups (DRGs) have been adopted for hospital services reimbursement. In some Italian regions, nurse staffing allocation is purely volume-based, with different minutes/patient/day categories determined by the type of hospital ward. The Information System of Nursing Performance (SIPI) is a valid and reliable tool assessing nursing care complexity as an indicator of the actual nursing care demand. Evidence is lacking about the ability of current resource allocation methods to account for the nursing care demand.
To evaluate the association between (1) DRG rates and nursing care complexity and (2) hospital ward categories of nurse staffing and nursing care complexity.
All patients discharged from the medical department of an Italian hospital over a data collection period were eligible. To assess the association between nursing care complexity (SIPI) and DRGs, the distribution of the DRG rate (median and first-third quartile) was compared for cases with high or low complexity. To evaluate the association between nursing care complexity (SIPI) and nurse staffing, the frequency of high complexity within nurse staffing categories (120/180/240 min/patient/day) was compared. Because the sample was very large, methods of statistical inference were not applied, and only descriptive measures were reported.
6872 hospitalizations were included. The median DRG rate for high and low complexity admissions were very similar (EUR 3536 and EUR 3285, respectively). The proportion of admissions with high complexity decreased for wards with higher staffing allocation rates.
DRG reimbursement and the nurse staffing allocation systems were ineffective in accounting for nursing care complexity. The SIPI could help identify areas requiring more financial and staffing resources for nursing care.
在意大利，诊断相关分组（DRGs）已被用于医院服务报销。在意大利的一些地区，护士人员配置分配纯粹基于工作量，不同的分钟/患者/天类别由医院病房类型决定。护理绩效信息系统（SIPI）是一个有效且可靠的工具，可将护理复杂性评估为实际护理需求的指标。目前缺乏关于现有资源分配方法考虑护理需求能力的证据。
评估（1）DRG费率与护理复杂性之间的关联，以及（2）护士人员配置的医院病房类别与护理复杂性之间的关联。
在数据收集期间从一家意大利医院内科出院的所有患者均符合条件。为了评估护理复杂性（SIPI）与DRGs之间的关联，比较了高复杂性或低复杂性病例的DRG费率分布（中位数和第一三分位数）。为了评估护理复杂性（SIPI）与护士人员配置之间的关联，比较了护士人员配置类别（120/180/240分钟/患者/天）内高复杂性的频率。由于样本量非常大，未应用统计推断方法，仅报告了描述性指标。
纳入6872例住院病例。高复杂性和低复杂性入院病例的DRG费率中位数非常相似（分别为3536欧元和3285欧元）。人员配置分配率较高的病房中，高复杂性入院病例的比例有所下降。
DRG报销和护士人员配置分配系统在考虑护理复杂性方面无效。SIPI有助于确定需要更多护理资金和人员资源的领域。
