Background

Higher staffing levels in long-term care have been associated with better outcomes for residents in several landmark studies. However previous systematic reviews found mixed results, calling into question the effectiveness of higher levels of staff. With persistent concerns about quality, rising resident acuity, and a growing demographic of seniors requiring more services, understanding the relationship between quality and long-term care staffing is a growing concern.

Objectives

This review considered the following question: What is the influence of nursing and personal care staffing levels (registered nurse, licensed practical nurse, and nursing assistant) and / or skill mix on long-term care residents, measured by quality of care indicators?

Design

Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guided the report of this systematic review.

Data sources

Published articles focused on quality and nursing and personal care staffing in long-term care in peer-reviewed databases (MEDLINE, CINAHL, and AGELINE) and several Cochrane databases to retrieve studies published between January 2008 and June 2020.

Review methods

A systematic review was conducted. 11,096 studies were identified, of which 34 were included in this review. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to evaluate study quality and risk of bias, and five quality measures were selected for in-depth analyses: pressure ulcers, hospitalizations, physical restraints, deficiencies and catherization.

Results

This review confirms previous review findings that evidence on the relationships between quality and long-term care staffing level and skill mix, remain mixed. Higher staffing levels and skill mix generally supported better rather than worse outcomes. Significant and consistent findings were more evident when staffing levels were further analyzed by indicator and staffing category. For example, registered nurses were consistently associated with significantly fewer pressure ulcers, hospitalizations, and urinary tract infections. Few studies examined the impact of total nursing and personal care hours compared to the impact of specific categories or classes of nursing staff on outcomes.

Conclusions

Evidence on the relationship between quality and long-term care staffing remains mixed, however some categories of nursing staff may be more effective at improving the quality of certain indicators. Study quality has improved minimally over the last decade. Although research continues to standardize units of measurement, and longitudinal and instrumental variable analyses are increasingly being used, very few studies controlled for endogeneity, conducted adequate risk-adjustment, and used resident-level data. Additional strides must still be made to improve the rigour of long-term care staffing research.

中文翻译：

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长期护理质量与人员配备之间的关系：2008-2020 年文献系统评价

背景

在几项具有里程碑意义的研究中，长期护理人员配备水平越高，居民的预后越好。然而，以前的系统评价发现了不同的结果，质疑更高级别员工的有效性。随着对质量的持续关注、居民敏锐度的提高以及需要更多服务的老年人口不断增长，了解质量与长期护理人员配备之间的关系越来越受到关注。

目标

这篇综述考虑了以下问题：护理和个人护理人员配备水平（注册护士、执业护士和护理助理）和/或技能组合对长期护理居民的影响是什么，以护理质量指标衡量？

设计

系统评价和荟萃分析协议的首选报告项目指导了本系统评价的报告。

数据源

在同行评审数据库（MEDLINE、CINAHL 和 AGELINE）和几个 Cochrane 数据库中发表的文章侧重于长期护理中的质量、护理和个人护理人员配置，以检索 2008 年 1 月至 2020 年 6 月期间发表的研究。

审查方法

进行了系统评价。确定了 11,096 项研究，其中 34 项被纳入本次审查。加强流行病学观察性研究报告清单用于评估研究质量和偏倚风险，并选择了五种质量指标进行深入分析：压疮、住院、身体约束、缺陷和导管插入。

结果

该审查证实了先前的审查结果，即质量与长期护理人员配备水平和技能组合之间关系的证据仍然混杂。更高的人员配备水平和技能组合通常支持更好而不是更差的结果。当按指标和人员配备类别进一步分析人员配备水平时，显着和一致的结果更加明显。例如，注册护士始终与显着减少压疮、住院和尿路感染有关。与特定类别或类别的护理人员对结果的影响相比，很少有研究检查总护理时间和个人护理时间的影响。

结论

关于质量和长期护理人员配备之间关系的证据仍然混杂，但某些类别的护理人员可能更有效地提高某些指标的质量。在过去十年中，学习质量略有提高。尽管研究继续使测量单位标准化，并且越来越多地使用纵向和工具变量分析，但很少有研究控制内生性，进行充分的风险调整并使用居民级数据。仍然必须取得更大的进步，以提高长期护理人员配置研究的严谨性。