Differences in Hospital Nursing Resources among Black-Serving Hospitals as a Driver of Patient Outcomes Disparities

黑人服务医院之间医院护理资源的差异是患者结果差异的驱动因素

基本信息

批准号：
10633905
负责人：
Karen Blanchette Lasater
金额：
$ 40.63万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10633905
关键词：
Academy Accounting Address Admission activity Advanced Practice Nurse Advocate Affect Age Attention Beds Black American Black Populations Black race COVID-19 mortality COVID-19 pandemic Caring Characteristics Clinical Clinical Nursing Communities Comprehensive Health Care Data Decision Making Desegregation Diagnosis Discipline of Nursing Disparity Educational process of instructing Elderly Family Floor Fostering Goals Healthcare Healthcare Systems Hospital Nursing Hospitalists Hospitalization Hospitals Individual Inequity Infrastructure Intervention Investments Legal Length of Stay Linear Regressions Link Logistic Regressions Measures Medical Medicare Medicine Modeling New York City Nurse&apos s Role Nurses Nursing Staff Observational Study Operative Surgical Procedures Outcome Patient Care Patient-Focused Outcomes Patients Physicians Policies Quality of Care Racial Segregation Records Registered nurse Reporting Research Resources Severity of illness Surveys Teaching Hospitals Technology Translational Research Urban Hospitals black patient care outcomes comorbidity coronavirus disease disparity reduction fortification health determinants health equity hospital care hospital readmission improved improved outcome indexing minority patient mortality novel strategies outcome disparities poor health outcome professional atmosphere racial disparity racial health disparity racial minority racism recruit response sex skills social social health determinants

项目摘要

Black Americans are more likely to receive care in lower quality hospitals that confer worse health outcomes to patients. The intractable hospital outcomes disparities have been described for decades and most recently came to the forefront of public attention with COVID-19 mortality disproportionally affecting Black communities. Despite multiple studies which attribute a large share of outcome disparities to quality differences in hospitals where significant proportions of Black patients are treated (i.e., Black-serving hospitals), little is known about what modifiable factors underlie the poorer quality care. This proposal takes a multilevel perspective to identify the contributions of individual, social, and hospital determinants to identify modifiable factors that can be targeted through `upstream' interventions to achieve health equity for Black individuals. We hypothesize that disparities in hospital outcomes are due, in large part, to inequities in the modifiable nurse resources of hospitals—with fewer nurse resources in Black-serving hospitals. This uneven distribution of nurse resources is a vestige of racism that continues to pervade hospital care more than 50 years after the legal desegregation of hospitals. We focus on nurse resources, since having enough nursing staff to deliver timely and effective care, a favorable work environment in which nurses have clinical autonomy in their practice and strong interdisciplinary teamwork, a skill mix rich in registered nurses, and high proportions of bachelors-prepared nurses and advanced practice nurses, have all been associated with better patient outcomes, particularly for minority patients. In this study, we evaluate the impact of hospital-level differences in nurse resources on patient outcomes, including in-hospital and 30-day mortality, readmission, and hospital length of stay. This observational study of over 900,000 older adult patients in nearly 250 hospitals investigates (1) whether differences in nurse resources between Black-serving and other hospitals explain outcomes disparities; (2) whether the outcomes-advantages of having superior hospital nurse resources are enhanced in the presence of other hospital characteristics, including for example, physician staffing, greater numbers of APRNs, or teaching hospitals; and (3) estimates the improvements in patient outcomes, such as lives saved, that could be expected if nurse resources in Black-serving hospitals were similar to other hospitals. Nurse resources are measured using survey data from over 16,000 nurses in nearly 250 hospitals to describe multiple aspects of the clinical nurse resources. Using a unique hospital identifier, nurse responses will be linked with Medicare patient records, demographic and social determinant of health indices. Our analytic approach uses multi-level nested (hierarchically-related) linear and logistic regression models (with interaction terms) to accomplish our aims. If our hypotheses are confirmed, the findings will add evidence to inform high-impact actionable `upstream' solutions to dismantle structural remnants of racism that pervade our healthcare system, by leveraging the most abundant patient care resource already existing in every hospital—nurses.

黑人美国人更有可能在较低质量的医院接受护理，这会使健康状况更糟患者。几十年来描述了棘手的医院成果分布 19岁的死亡率不成比例地影响黑人社区，成为公众关注的最前沿。尽管有多项研究将大量结果差异归因于医院的质量差异如果对黑人患者的大量比例进行治疗（即黑人服务医院），对哪些可修改的因素是质量较差的护理的基础。该建议需要多层次的观点来识别个人，社会和医院决定者的贡献，以确定可修改的因素通过“上游”干预措施的目标，以实现黑人的健康公平。我们假设这一点医院结局的差异很大程度上是由于可修改的护士资源的不平等医院 - 黑服务医院的护士资源减少。护士资源的这种不平衡分配是种族主义的遗迹，在法律种族隔离之后50年以上，继续遍及医院护理医院。我们专注于护士资源，因为有足够的护士人员来及时有效护理，一个有利的工作环境，护士在实践中具有临床自主权，并且很强跨学科的团队合作，一种丰富的注册护士的技能组合，并为单身汉准备了高比例护士和高级练习护士都与更好的患者结局有关，特别是少数族裔患者。在这项研究中，我们评估了医院水平差异对护士资源的影响患者的结果，包括院内和30天死亡率，再入院和住院时间。这对近250家医院中900,000多名老年患者的观察性研究研究（1）是否是否黑人服务和其他医院之间护士资源的差异解释了结果分布；（2）在场的情况下，拥有优越的医院护士资源的结果是否得到增强其他医院特征，包括身体人员配备，更多的APRN或教学医院；（3）估计患者预后的改善，例如挽救的生命，可能是如果黑人服务医院中的护士资源与其他医院相似，那么预计。护士资源是使用来自近250家医院的16,000多名护士的调查数据来描述使用唯一的医院标识符，护士的回复将与Medicare联系患者记录，人口统计学和社会确定者的健康指数。我们的分析方法使用多层次嵌套（与层次相关的）线性和逻辑回归模型（具有相互作用项）以完成我们的目标。如果确认我们的假设，这些发现将添加证据，以告知高影响力 ``上游''解决方案，以消除遍布我们医疗体系的种族主义的结构性残留物，利用每家医院已经存在的最丰富的患者护理资源（Nurses）。