BACKGROUND In Japan, the revision of the fee schedules in 2006 introduced a new category of general care ward for more advanced care, with a higher staffing standard, a patient-to-nurse ratio of 7:1. Previous studies have suggested that these changes worsened inequalities in the geographic distribution of nurses, but there have been few quantitative studies evaluating this effect. This study aimed to investigate the association between the distribution of 7:1 beds and the geographic distribution of hospital nursing staffs. METHODS We conducted a secondary data analysis of hospital reimbursement reports in 2012 in Japan. The study units were secondary medical areas (SMAs) in Japan, which are roughly comparable to hospital service areas in the United States. The outcome variable was the nurse density per 100,000 population in each SMA. The 7:1 bed density per 100,000 population was the main independent variable. To investigate the association between the nurse density and 7:1 bed density, adjusting for other variables, we applied a multiple linear regression model, with nurse density as an outcome variable, and the bed densities by functional category of inpatient ward as independent variables, adding other variables related to socio-economic status and nurse workforce. To investigate whether 7:1 bed density made the largest contribution to the nurse density, compared to other bed densities, we estimated the standardized regression coefficients. RESULTS There were 344 SMAs in the study period, of which 343 were used because of data availability. There were approximately 553,600 full time equivalent nurses working in inpatient wards in hospitals. The mean (standard deviation) of the full time equivalent nurse density was 426.4 (147.5) and for 7:1 bed density, the figures were 271.9 (185.9). The 7:1 bed density ranged from 0.0 to 1,295.5. After adjusting for the possible confounders, there were more hospital nurses in the areas with higher densities of 7:1 beds (standardized regression coefficient 0.62, 95% confidence interval 0.56-0.68). CONCLUSION We found that the 7:1 nurse staffing standard made the largest contribution to the geographic distribution of hospital nurses, adjusted for socio-economic status and nurse workforce-related factors.

中文翻译：

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费用表中较高的护士人员配置标准与医院护士地理分布之间的关联：使用全国行政数据的横断面研究。


背景 在日本，2006 年收费表的修订引入了一种新类别的普通护理病房，提供更高级的护理，人员配备标准更高，患者与护士的比例为 7:1。先前的研究表明，这些变化加剧了护士地理分布的不平等，但很少有定量研究评估这种影响。本研究旨在探讨7:1床位分布与医院护理人员地理分布之间的关系。方法 我们对 2012 年日本医院报销报告进行了二次数据分析。研究单位是日本的二级医疗区（SMA），与美国的医院服务区大致相当。结果变量是每个 SMA 每 100,000 人的护士密度。每10万人7:1的床位密度是主要的自变量。为了研究护士密度和 7:1 床位密度之间的关联，调整其他变量，我们应用了多元线性回归模型，以护士密度作为结果变量，以住院病房功能类别的床位密度作为自变量，添加与社会经济地位和护士队伍相关的其他变量。为了调查 7:1 的床位密度是否对护士密度的贡献最大，与其他床位密度相比，我们估计了标准化回归系数。结果 研究期间共有 344 个 SMA，其中 343 个因数据可用性而被使用。大约有 553,600 名全职护士在医院住院病房工作。全职等效护士密度的平均值（标准差）为 426.4（147.4）。5) 对于 7:1 床密度，该数字为 271.9 (185.9)。 7:1 床密度范围为 0.0 至 1,295.5。调整可能的混杂因素后，床位密度为 7:1 的地区医院护士数量较多（标准化回归系数 0.62，95% 置信区间 0.56-0.68）。结论 我们发现，根据社会经济地位和护士队伍相关因素进行调整后，7:1 的护士人员配置标准对医院护士的地理分布影响最大。