Moronski Lynne, Chittams Jesse L, Lake Eileen T, McHugh Matthew D
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA.
Leonard Davis Institute for Health Economics, Philadelphia, PA.
Med Care. 2025 Sep 1;63(9):672-678. doi: 10.1097/MLR.0000000000002168. Epub 2025 May 28.
Complex care for individuals with intellectual and developmental disability (IDD) may translate into longer than needed hospital lengths of stay (LOS). Nurses are poised to influence the outcomes of patients with IDD. But ample evidence suggests that nurses' capacity to provide optimal care may depend on key organizational features such as having sufficient staff, supportive work environments, and sufficient mix of registered nurses, termed nursing resources. This paper aims to determine the association of nursing resource factors with LOS in adults with IDD.
Linked data from 3 datasets representing 4 states were used. Zero-truncated negative binomial regression models that clustered for patients in the same hospital were used to examine the association between nursing resources and LOS for adults with IDD.
Receiving care in a hospital with a better nurse work environment, skill mix, and staffing was associated with reduced LOS in this sample of 38,587 patients with IDD in 595 hospitals. In univariate models adjusted for hospital and patient characteristics, all 3 nursing resources were independently associated with reduced LOS. In an adjusted multivariate model, work environment and skill mix remained significant with identical effect sizes to the separate models, that is, for an increase of 1 SD, work environment is associated with a reduction in LOS of 2.7% (P=0.005), a 6 day to 5.84 day reduction, and skill mix of 2% (P=0.039), a 6 day to 5.88 day reduction.
The appropriate deployment of nursing resources may lead to a reduction in LOS for patients with IDD.
为智力和发育障碍（IDD）患者提供的复杂护理可能会导致住院时间（LOS）比所需时间更长。护士有能力影响IDD患者的治疗结果。但大量证据表明，护士提供最佳护理的能力可能取决于关键的组织特征，如人员充足、工作环境支持性好以及注册护士的充分配置，即护理资源。本文旨在确定护理资源因素与IDD成年患者住院时间之间的关联。
使用来自代表4个州的3个数据集的关联数据。采用对同一医院患者进行聚类的零截断负二项回归模型，以检验护理资源与IDD成年患者住院时间之间的关联。
在护士工作环境更好、技能组合更佳且人员配备充足的医院接受护理，与本研究中595家医院的38587名IDD患者住院时间缩短相关。在针对医院和患者特征进行调整的单变量模型中，所有3种护理资源均与住院时间缩短独立相关。在调整后的多变量模型中，工作环境和技能组合仍然显著，效应大小与单独模型相同，即每增加1个标准差，工作环境与住院时间缩短2.7%（P = 0.005）相关，从6天缩短至5.84天，技能组合与住院时间缩短2%（P = 0.039）相关，从6天缩短至5.88天。
合理配置护理资源可能会缩短IDD患者的住院时间。
