Turi Eleanor, Lasater Karen B, Kamen Ariel S, Aiken Linda H, Muir K Jane
University of Pennsylvania Perelman School of Medicine National Clinician Scholars Program & Center for Mental Health, University of Pennsylvania Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA.
University of Pennsylvania School of Nursing Center for Health Outcomes & Policy Research, University of Pennsylvania Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA.
J Clin Nurs. 2025 Apr 28. doi: 10.1111/jocn.17804.
Evaluate the relationship between hospital nursing resources and outcomes among patients with chronic wounds.
Cross-sectional observational.
Hospital-level predictors included the nurse work environment, proportion of Bachelor of Science (BSN)-prepared nurses, and skill mix (i.e., registered nurses [RN] as proportion of nursing personnel). Outcomes included in-hospital and 30-day mortality, discharging to a higher level of care and length of stay. Individual-level nurse data were aggregated to create hospital-level measures of nursing resources. We utilised multi-level modelling with nurses nested within hospitals and outcomes at the patient level.
Three datasets from 2021: RN4CAST-New York/Illinois survey, Medicare Provider Analysis and Review claims and American Hospital Association Annual Survey.
The sample included 34,113 patients with chronic wounds in 215 hospitals in New York and Illinois. In adjusted models, a 1 standard deviation improvement in the work environment was associated with 12% lower odds of in-hospital mortality, 8% lower odds of discharging to a higher level of care and a shorter length of stay by a factor of 0.96. A 10% increase in BSN composition was associated with 8% reduced odds of in-hospital mortality and 6% reduced odds of 30-day mortality. A 10% increase in skill mix was associated with 12% lower odds of in-hospital mortality and a shorter length of stay by a factor of 0.91.
Improved nursing resources are associated with better outcomes among patients with chronic wounds.
Nurses manage the care of patients with chronic wounds; thus, hospital investment in nursing resources is imperative for good outcomes.
Modifiable hospital nursing resources are associated with outcomes among patients with chronic wounds, a complex population.
STROBE.
评估慢性伤口患者的医院护理资源与治疗结果之间的关系。
横断面观察性研究。
医院层面的预测因素包括护士工作环境、拥有护理学学士学位（BSN）的护士比例以及技能组合（即注册护士[RN]占护理人员的比例）。结果包括住院死亡率和30天死亡率、转至更高护理级别以及住院时间。将个体层面的护士数据进行汇总，以创建医院层面的护理资源指标。我们采用多层次模型，护士嵌套在医院中，结果以患者层面的数据为准。
来自2021年的三个数据集：RN4CAST-纽约/伊利诺伊州调查、医疗保险提供者分析与审查索赔数据以及美国医院协会年度调查。
样本包括纽约和伊利诺伊州215家医院的34,113例慢性伤口患者。在调整后的模型中，工作环境改善1个标准差与住院死亡率降低12%、转至更高护理级别几率降低8%以及住院时间缩短至0.96倍相关。BSN护士比例增加10%与住院死亡率降低8%和30天死亡率降低6%相关。技能组合增加10%与住院死亡率降低12%以及住院时间缩短至0.91倍相关。
改善护理资源与慢性伤口患者更好的治疗结果相关。
护士负责管理慢性伤口患者的护理；因此，医院对护理资源的投入对于取得良好治疗效果至关重要。
可改变的医院护理资源与慢性伤口患者（这一复杂人群）的治疗结果相关。
采用STROBE标准。
