Health human resource planning: An examination of relationships among nursing service utilization, and estimate of population health, and overall health outcomes in the province of Ontario.

摘要

Past health human resource planning has been based on utilization patterns, the supply of health care professionals, and budgetary capacity, rather than on population health care needs and health policies. Using the Health Human Resource Planning Conceptual Framework this study estimated the association between the level of nursing inputs and patient outcomes in acute care hospitals in Ontario, Canada. The impact of different levels of hospital-based and community-based nursing provision on health care outcomes was considered. The research questions were: (1) does variation in hospital-based nursing service utilization explain variation in hospital-based outcomes; and (2) does variations in individuals' self-reported hospital use explain variation in self reported health status? (3) does variation in individuals' self-reported use of community nursing care explain variation in self reported health status?; The study used hospital level utilization data from administrative data bases and self reported individual level data from a population health survey for Ontario, Canada. Logistic regression methods are used to estimate models for the incidence of utilisation and a double-hurdle model is employed to account for heterogeneity in the study sample. After controlling for supply of nurses, workload, community characteristics and hospital type, nursing hours per patient day had a significant negative effect on patients' length of stay. In other words, the more nursing hours in a hospital, the shorter the average length of patient stays in that hospital.; The findings suggest that decisions about the deployment of nursing resources are associated with differences in service outcomes. In particular, great intensity of nursing inputs is associated with shorter lengths of stay. However there was no evidence that this resulted in poorer patient outcomes as measured by higher rates of readmission, lower levels of patient satisfaction or lower levels of self reported health. This information is important to both health care managers and health human resources planners human resources planning in their efforts to deploy efficient mixes of health care resources and identify future human resource requirements to support the efficient provision of health human resources.