A Panel Study of Hospital Nursing Resources and Racial Disparities in Elder Outcomes

医院护理资源与老年人结局种族差异的小组研究

• 批准号: 9562950
• 负责人: Matthew D. McHugh
• 金额: $ 33.01万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9562950
• 关键词: Accounting; Caring; Characteristics; Client satisfaction; Data; Data Set; Decision Making; Discipline of Nursing; Elderly; Etiology; Failure; Health; Hospital Nursing; Hospitals; Individual; Institute of Medicine (U.S.); Intensive Care; Intervention; Investments; Learning; Length of Stay; Link; Low income; Measures; Medicaid; Medical; Medicare; Minority; Nosocomial Infections; Nurses; Nursing Education; Nursing Staff; Operative Surgical Procedures; Outcome; Paper; Patient-Focused Outcomes; Patients; Policies; Quality of Care; Race; Reporting; Research; Resources; Role; Sampling; Socioeconomic Factors; Socioeconomic Status; Source; Time; United States Centers for Medicare and Medicaid Services; Work; beneficiary; care outcomes; collaborative environment; cost; disparity reduction; evidence base; health disparity; hospital readmission; improved; minority-serving hospitals; mortality; policy implication; prevent; programs; protective effect; racial and ethnic disparities; racial disparity; readmission risk; skills

A Panel Study of Hospital Nursing Resources and Racial Disparities in Elder Outcomes More than 10 years since the Institute of Medicine's landmark Unequal Treatment report, racial and ethnic disparities in costly and often preventable poor outcomes persist for hospitalized older adults. Evidence points to differences in the hospitals where minorities and whites receive care as a source of disparities. Our original study findings suggest that nursing resource differences (nurse staffing, nurses' educational and skill levels, and nurse work environments) between hospitals may be an important factor underlying racial disparities. Our work thus far however has been restricted to cross-sectional data, preventing us from concluding whether the relationship between nursing resources and disparities is a causal one and whether interventions to improve nursing resources will work as intended. The study we propose in this renewal application takes the important next step to advance policy interventions by using new and unique panel data on hospital nursing and older adult patient outcomes in four large states to evaluate whether differences in outcomes between minority and white patients result from differences between minority and white patients, differences in nursing resources in the hospitals that minority and white patients receive care in, and/or differences in the care minority and white patients receive, even when they are treated in the same hospitals with similar nursing resources. We make efficient use of existing data from repeated cross-sections of hundreds of thousands of patients nested in a panel of over six hundred hospitals at two points in time. This provides a unique opportunity to examine well- known but poorly understood disparities from two distinct but complementary vantage points. First, by examining cross-sections spanning nearly a decade, we gain a better understanding of the role of individual and organizational factors in disparities in older adult hospital outcomes. Importantly, we will learn whether associations between nursing and outcomes disparities in 2015 are similar to those in the same hospital sample in 2006 and whether they differ for whites and minorities. Evidence supporting the stability of associations over time increases our warrant for concluding that connections are causal. Our second aim is to examine hospital-level changes in nursing resources over time, determine whether those changes differed for hospitals predominantly serving minority patients, and determine whether changes in outcomes disparities between minority and white patients result from changes in hospital nursing resources over time. It is important for causation and policy implications to know whether nursing resources improved less in minority serving hospitals. The panel data we will analyze will allow us to assess this, and to determine whether hospital outcomes disparities have grown (or narrowed) and whether nursing resource changes are linked with these changes. Furthermore, we will determine if the changes in nursing resources in minority serving hospitals has contributed to widening or reducing outcomes disparities between white and minority patients. Better causal evidence between nursing resources and patient outcomes can spur evidence-based decision-making.

医院护理资源与老年人结局种族差异的小组研究 自医学研究所发表具有里程碑意义的不平等待遇报告以来十多年了，种族和民族 对于住院的老年人来说，成本高昂但通常可以预防的不良结果仍然存在差异。证据点 少数族裔和白人接受护理的医院的差异是造成差异的一个根源。我们原创的 研究结果表明，护理资源差异（护士人员配置、护士教育和技能水平、 医院之间的种族差异和护士工作环境）可能是造成种族差异的一个重要因素。我们的 然而，迄今为止的工作仅限于横截面数据，使我们无法得出结论： 护理资源与差异之间的关系是否存在因果关系以及干预措施能否改善 护理资源将按预期发挥作用。我们在此更新申请中提出的研究非常重要 下一步是通过使用关于医院护理和老年人的新的和独特的面板数据来推进政策干预 四个大州的成年患者结局，以评估少数族裔和少数族裔之间的结局是否存在差异 白人患者是由于少数族裔和白人患者之间的差异、护理资源的差异造成的 少数族裔和白人患者接受护理的医院，和/或少数民族和白人护理方面的差异 即使患者在具有相似护理资源的同一家医院接受治疗，也可以接受治疗。我们做 有效利用来自数十万患者重复横截面的现有数据 小组在两个时间点由六百多家医院组成。这提供了一个独特的机会来检查良好 从两个不同但互补的角度来看，人们知道但知之甚少的差异。首先，由 通过研究近十年来的横截面，我们可以更好地理解个人的作用 老年人医院结果差异的组织因素。重要的是，我们将了解是否 2015 年护理与结果差异之间的关联与同一家医院的相似 2006 年的样本以及它们对于白人和少数族裔是否有所不同。支持稳定性的证据 随着时间的推移，关联性增加了我们得出因果关系结论的依据。我们的第二个目标是 检查医院层面护理资源随时间的变化，确定这些变化是否因时间而异 主要为少数族裔患者服务的医院，并确定结果差异是否发生变化 少数族裔和白人患者之间的差异是由于医院护理资源随着时间的推移而发生的变化造成的。这很重要 因果关系和政策影响，以了解护理资源在少数族裔服务中是否改善较少 医院。我们将分析的面板数据将使我们能够对此进行评估，并确定医院是否 结果差异扩大（或缩小），以及护理资源变化是否与这些相关 变化。此外，我们将确定少数族裔服务医院的护理资源变化是否有影响。 有助于扩大或减少白人和少数族裔患者之间的结果差异。更好的因果关系 护理资源和患者结果之间的证据可以促进基于证据的决策。