养老院人员和健康结果之间的关系被重新审视
Dana B Mukamel1, Debra Saliba2, Heather Ladd1
1Department of Medicine, Division of General Internal Medicine, iTEQC Research Program, University of California, Irvine, CA, USA.
Journal of the American Medical Directors Association
|June 15, 2024
概括
考虑到内源性偏差在养老院研究中至关重要. 仪表变量表明,人员数量有很大影响质量指标,改变了以前关于它们关系的结论.
科学领域:
- 老年学是一门学科.
- 医疗保健服务研究 医疗服务研究
- 养老院的质量 养老院的质量
背景情况:
- 养老院人员决策往往与质量目标交织在一起,从而产生潜在的内源性偏见.
- 由于这种偏见,现有的研究可能不准确地代表了人员和质量之间的关系.
研究的目的:
- 通过使用仪表变量 (IVs) 来解决内源性,研究养老院人员数量和质量指标之间的关系.
- 确定内源性会计如何影响注册护士 (RN),执照实践护士 (LPN) 和认证护士助理 (CNA) 对质量的估计影响.
主要方法:
- 对2017-2019年国家养老院数据的回顾性分析.
- 采用普通最小平方 (OLS) 和2阶段最小平方 (2SLS) 方法来估计6个质量指标的模型.
- 利用竞争的养老院的平均员工人数作为控制内源性的工具变量.
主要成果:
- 2SLS模型显示系数高达OLS的5倍,表明显著的内源性.
- 较高的RN人员数量与减少抗精神病药物使用,住院和急诊室访问有关.
- 增加CNA人员数量与减少抗精神病药物使用,住院治疗和改善日常生活功能有关.
- 减少LPN人员数量与住院病例的减少相关,而RN在减少压力的关键作用.
结论:
- 内源性显著影响养老院人员和质量结果之间的感知关系.
- 调查结果强调了使用IVs等方法的必要性,以准确评估人员的真正影响.
- 需要进一步的研究来探索不同类型的护理人员对特定质量指标的微妙影响.
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