科研之友
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摘要
ObjectiveThe aims of the study were to (1) estimate the relative nurse effectiveness, or individual nurse value-added (NVA), to patients%26apos; clinical condition change during hospitalization; (2) examine nurse characteristics contributing to NVA; and (3) estimate the contribution of value-added nursing care to patient outcomes. %26lt;br%26gt;Data Sources/Study SettingElectronic data on 1,203 staff nurses matched with 7,318 adult medical-surgical patients discharged between July 1, 2011 and December 31, 2011 from an urban Magnet-designated, 854-bed teaching hospital. %26lt;br%26gt;Study DesignRetrospective observational longitudinal analysis using a covariate-adjustment value-added model with nurse fixed effects. %26lt;br%26gt;Data Collection/Extraction MethodsData were extracted from the study hospital%26apos;s electronic patient records and human resources databases. %26lt;br%26gt;Principal FindingsNurse effects were jointly significant and explained 7.9 percent of variance in patient clinical condition change during hospitalization. NVA was positively associated with having a baccalaureate degree or higher (0.55, p=.04) and expertise level (0.66, p=.03). NVA contributed to patient outcomes of shorter length of stay and lower costs. %26lt;br%26gt;ConclusionsNurses differ in their value-added to patient outcomes. The ability to measure individual nurse relative value-added opens the possibility for development of performance metrics, performance-based rankings, and merit-based salary schemes to improve patient outcomes and reduce costs.
- 出版日期2014-12
