Carr-Hill R A, Dixon P, Griffiths M, Higgins M, McCaughan D, Rice N, Wright K
Centre for Health Economics, University of York, UK.
Health Econ. 1995 Jan-Feb;4(1):57-72. doi: 10.1002/hec.4730040106.
The large industry which has grown up around the estimation of nursing requirements for a ward or for a hospital takes little account of variations in nursing skill; meanwhile nursing researchers tend to concentrate on the appropriate organisation of the nursing process to deliver best quality care. This paper, drawing on a Department of Health funded study, analyses the relation between skill mix of a group of nurses and the quality of care provided. Detailed data was collected on 15 wards at 7 sites on both the quality and outcome of care delivered by nurses of different grades, which allowed for analysis at several levels from a specific nurse-patient interaction to the shift sessions. The analysis shows a strong grade effect at the lowest level which is 'diluted' at each succeeding level of aggregation; there is also a strong ward effect at each of the lower levels of aggregation. The conclusion is simple; you pay for quality care.
围绕病房或医院护理需求评估发展起来的庞大产业很少考虑护理技能的差异；与此同时，护理研究人员倾向于专注于护理过程的合理组织以提供最佳质量的护理。本文基于一项由卫生部资助的研究，分析了一组护士的技能组合与所提供护理质量之间的关系。收集了7个地点15个病房关于不同级别护士提供护理的质量和结果的详细数据，这使得能够从特定的护患互动到轮班时段等多个层面进行分析。分析表明，在最低层面存在很强的级别效应，而在每个后续的汇总层面这种效应会“减弱”；在较低的汇总层面的每一层也存在很强的病房效应。结论很简单：优质护理是要付出代价的。
