养老院员工流动与感染控制处罚之间的关联。
Association between nursing home staff turnover and infection control citations.
机构信息
Department of Economics and Health Care Management, Labovitz School of Business and Economics, University of Minnesota Duluth, Duluth, Minnesota, USA.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Health Serv Res. 2022 Apr;57(2):322-332. doi: 10.1111/1475-6773.13877. Epub 2021 Sep 21.
OBJECTIVE
To describe the association between nursing home staff turnover and the presence and scope of infection control citations.
DATA SOURCES
Secondary data for all US nursing homes between March 31, 2017, through December 31, 2019 were obtained from Payroll-Based Journal (PBJ), Nursing Home Compare, and Long-Term Care: Facts on Care in the US (LTC Focus).
STUDY DESIGN
We estimated the association between nurse turnover and the probability of an infection control citation and the scope of the citation while controlling for nursing home fixed effects. Our turnover measure is the percent of the facility's nursing staff hours that were provided by new staff (less than 60 days of experience in the last 180 days) during the 2 weeks prior to the health inspection. We calculated turnover for all staff together and separately for registered nurses, licensed practical nurses (LPNs), and certified nursing assistants.
DATA COLLECTION/EXTRACTION METHODS: We linked nursing homes standard inspection surveys to 650 million shifts from the PBJ data. We excluded any nursing home with incomplete or missing staffing data. Our final analytic sample included 12,550 nursing homes with 30,536 surveys.
PRINCIPAL FINDINGS
Staff turnover was associated with an increased likelihood of an infection control citation (average marginal effect [AME] = 0.12 percentage points [pp]; 95% confidence interval [CI]: 0.05, 0.18). LPN (AME = 0.06 pp; 95% CI: 0.01, 0.11) turnover was conditionally associated with an infection control citation. Conditional on having at least an isolated citation for infection control, staff turnover was positively associated with receiving a citation coded as a "pattern" (AME = 0.21 pp; 95% CI: 0.10, 0.32). Conditional of having at least a pattern citation, staff turnover was positively associated with receiving a widespread citation (AME = 0.21 pp; 95% CI: 0.10, 0.32).
CONCLUSIONS
Turnover was positively associated with the probability of an infection control citation. Staff turnover should be considered an important factor related to the spread of infections within nursing homes.
目的
描述养老院员工流动与感染控制引文的存在和范围之间的关系。
资料来源
从薪酬日记（PBJ）、养老院比较和长期护理：美国护理事实（LTC Focus）中获取了 2017 年 3 月 31 日至 2019 年 12 月 31 日期间美国所有养老院的二级数据。
研究设计
我们在控制养老院固定效应的情况下，估计护士流动与感染控制引文的概率和引文范围之间的关系。我们的流动衡量标准是设施护理人员在健康检查前两周内由新员工（在过去 180 天内少于 60 天的经验）提供的小时数占设施护理人员总小时数的百分比。我们一起计算了所有员工的流动率，并且分别为注册护士、持照实习护士（LPN）和注册护士助理计算了流动率。
资料收集/提取方法：我们将养老院标准检查调查与 PBJ 数据中的 6.5 亿班次联系起来。我们排除了任何 staffing 数据不完整或缺失的养老院。我们的最终分析样本包括 12550 家养老院，共 30536 项调查。
主要发现
员工流动与感染控制引文的可能性增加有关（平均边际效应 [AME] = 0.12 个百分点 [pp]；95%置信区间 [CI]：0.05，0.18）。LPN（AME = 0.06 pp；95%CI：0.01，0.11）流动与感染控制引文有条件相关。在至少有一个感染控制孤立引文的情况下，员工流动与收到一个编码为“模式”的引文呈正相关（AME = 0.21 pp；95%CI：0.10，0.32）。在至少有一个模式引文的情况下，员工流动与收到广泛引文呈正相关（AME = 0.21 pp；95%CI：0.10，0.32）。
结论
流动与感染控制引文的概率呈正相关。员工流动应被视为与养老院内部感染传播有关的一个重要因素。
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