点击蓝字
关注我们
1.文献信息：
Title:Costs and cost-effectiveness of improved nurse staffing levels and skill mix in acute hospitals: A systematic review.
改善急诊医院护士人员配备水平和技能组合的成本和成本效益:系统综述。
Journal:International Journal of Nursing Studies .
IF//JCR分区: 7.5/Q1.
Keyword:Economics ; Cost–benefit analysis ; Health workforce ; Personnel staffing and scheduling.
经济学；成本效益分析；卫生人力资源；人员配置和调动。
Design:A systematic review.
系统回顾。
2. 摘要 Abstract：
（译文仅供参考）
Background: Extensive research shows associations between increased nurse staffing levels, skill mix and patient outcomes. However, showing that improved staffing levels are linked to improved outcomes is not sufficient to provide a case for increasing them. This review of economic studies in acute hospitals aims to identify costs and consequences associated with different nurse staffing configurations in hospitals.
背景:广泛的研究表明，增加护士人员配备水平，技能组合和患者预后之间存在关联。然而，表明工作人员水平的提高与成果的改善有关，并不足以成为增加工作人员水平的理由。本文回顾了急诊医院的经济研究，旨在确定与医院不同护士配置相关的成本和后果。
Methods: We included economic studies exploring the effect of variation in nurse staffing. We searched PubMed, CINAHL, Embase Econlit, Cochrane library, DARE, NHS EED and the INAHTA website. Risk of bias was assessed using a framework based on the NICE guidance for public health reviews and Henrikson's framework for economic evaluations. Inclusion, data extraction and critical appraisal were undertaken by pairs of reviewers with disagreements resolved by the entire review team. Results were synthesised using a hierarchical matrix to summarise findings of economic evaluations.
方法:我们纳入经济学研究，探讨护士配备变化的影响。我们检索了PubMed、CINAHL、Embase Econlit、Cochrane library、DARE、NHS EED和INAHTA网站。使用基于NICE公共卫生评价指南和Henrikson经济评价框架评估偏倚风险。纳入、数据提取和关键评估由成对的评审人员进行，分歧由整个评审小组解决。使用层次矩阵来总结经济评估的结果。
Results: We found 23 observational studies conducted in the United States of America (16), Australia, Belgium, China, South Korea, and the United Kingdom (3). Fourteen had high risk of bias and nine moderate.Most studies addressed levels of staffing by RNs and/or licensed practical nurses. Six studies found that increased nurse staffing levels were associated with improved outcomes and reduced or unchanged net costs, but most showed increased costs and outcomes. Studies undertaken outside the USA showed that increased nurse staffing was likely to be cost-effective at a per capita gross domestic product (GDP) threshold or lower. Four studies found that increased skill mix was associated with improved outcomes but increased staff costs. Three studies considering net costs found increased registered nurse skill mix associated with net savings and similar or improved outcomes.
结果:我们在美国(16)、澳大利亚、比利时、中国、韩国和英国(3)进行了23项观察性研究。14项偏倚风险高，9项偏倚风险中等。大多数研究涉及注册护士和/或执业护士的人员配备水平。六项研究发现，增加护士人员配备水平与改善结果和减少或不变的净成本有关，但大多数研究显示成本和结果都有所增加。在美国以外进行的研究表明，在人均国内生产总值(GDP)阈值或更低的情况下，增加护士人员可能具有成本效益。四项研究发现，增加技能组合与改善结果有关，但增加了员工成本。三项考虑净成本的研究发现，注册护士技能组合的增加与净节省和类似或改善的结果相关。
Conclusion: Although more evidence on cost-effectiveness is still needed, increases in absolute or relative numbers of registered nurses in general medical and surgical wards have the potential to be highly costeffective. The preponderance of the evidence suggests that increasing the proportion of registered nurses is associated with improved outcomes and, potentially, reduced net cost. Conversely, policies that lead to a reduction in the proportion of registered nurses in nursing teams could give worse outcomes at increased costs and there is no evidence that such approaches are cost-effective. In an era of registered nurse scarcity, these results favour investment in registered nurse supply as opposed to using lesser qualified staff as substitutes, especially where baseline nurse staffing and skill mix are low.
结论:虽然成本效益还需要更多的证据，但普通内科和外科病房注册护士的绝对或相对数量的增加可能具有很高的成本效益。大量证据表明，增加注册护士的比例与改善结果有关，并可能降低净成本。相反，导致护理团队中注册护士比例减少的政策可能会在增加成本的情况下产生更糟糕的结果，而且没有证据表明这种方法具有成本效益。在注册护士稀缺的时代，这些结果有利于投资于注册护士供应，而不是使用较不合格的人员作为替代品，特别是在基线护士人员配备和技能组合较低的地方。
3.文献新知扩展：
①NICE公共卫生评价指南是什么
NICE（英国国家卫生与临床优化研究所）发布的公共卫生评价指南标准是一系列旨在改善公众健康的指导文件。这些指南基于最佳可用证据，涵盖了从疾病预防到健康促进的多个方面。NICE指南的制定过程包括系统地回顾证据、评估干预措施的有效性和成本效益，并考虑公平性、接受度以及实施和交付的可行性。
②Henrikson经济评价框架是什么
Henrikson经济评价框架是一种用于评估医疗干预措施经济效益的方法。这种框架强调在有限的资源下，通过比较不同医疗选项的成本和效果，来确定最具成本效益的干预措施。它通常涉及到识别和量化所有相关的成本和效果，包括直接医疗成本、间接成本、健康效用等，并将它们转化为可比较的货币单位。
③NHS EED是什么
英国国家卫生服务部卫生经济评价数据库（Electronic Data Research and Innovation Service ）的主要用途是提供高质量的经济评价文摘，这些评价系统地确认和描述经济评价内容，并评定经济评价的相对优势和弱势。NHS EED为决策者提供有关医疗保健干预的成本和效果信息，这些信息对于做出循证的决策至关重要，特别是在医疗资源有限的情况下。
参考资料：【笔记整理】英国NICE卫生技术评估（未完待续） - 知乎 (zhihu.com)
4.原文传递
✦
END
✦
