Achieving Health Equity During the COVID-19 Pandemic: Lessons Learned from Nurses and High Performing Hospitals

在 COVID-19 大流行期间实现健康公平：从护士和高绩效医院汲取的经验教训

基本信息

批准号：
10655888
负责人：
JACQUELINE MARGO BROOKS CARTHON
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：
2023-03-27 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10655888
关键词：
Accounting Address Attention Black Populations Black race COVID-19 COVID-19 disparity COVID-19 health disparity COVID-19 mortality COVID-19 pandemic Caring Characteristics Chronic Disease Communities Data Development Disadvantaged minority Discipline of Nursing Disparity Ensure Equity Ethnic Origin Evaluation Foundations Goals Health Insurance Hispanic Hispanic Populations Hospitalization Hospitals Illinois Individual Inequity Intervention Learning Link Literature Methods Minority National Institute of Nursing Research New York Nurses Nursing Research Nursing Staff Outcome Patient Admission Patient-Focused Outcomes Patients Perception Persons Phase Population Heterogeneity Primary Care Physician Process Race Registered nurse Research Resources Respondent Risk Factors Service delivery model Socioeconomic Factors Structure Surveys System Systems Development United States Variant Vulnerable Populations Work acute care barrier to care black patient burden of illness care delivery classification trees clinical care clinical risk community-level factor disparity reduction ethnic difference ethnic minority evidence base experience health care quality health disparity health equity health inequalities hospital care hospital readmission improved innovation minority patient mortality novel strategies nursing care quality outcome disparities pandemic disease professional atmosphere racial difference racial minority regression trees response social factors social vulnerability sociodemographic factors

项目摘要

Project Summary The COVID-19 pandemic catapulted long-standing racial/ethnic health inequities onto the national stage. Hospitalization and mortality rates for Black and Hispanic individuals with COVID-19 have been 2-3x higher than the rates of their White counterparts, drawing attention to the patient and system level factors underlying these differences, including the quality of hospitals to which minority patients are admitted. Of these studies, few have been able to identify the specific features of hospitals that explain the observed racial/ethnic differences in outcomes. Our study focuses on differences in nursing resources across hospitals, an important factor that has not been adequately addressed in the COVID-19 disparities literature. In this mixed methods proposal, we leverage administrative claims and unique survey data collected from over 22,000 nurses working in 244 New York and Illinois hospitals during the COVID pandemic (April-June 2021). We employ tapered multivariate matching, a novel approach which allows us to carefully control for differences in clinical risk and social factors between minority and white patients to clearly identify the basis of COVID-19 outcome disparities. Our primary objective is to examine how variations in nursing resources were associated with disparities in minority COVID- 19 outcomes, including mortality and readmissions. A second objective is to identify the nursing and hospital characteristics of “high performing” hospitals where such disparities were minimized. After identifying high and low performing hospitals, we will explore the open-ended responses of thousands of nurses who shared their perspectives of supports and barriers to care delivery for socially “vulnerable” populations, including racial and ethnic minorities. By examining patient, community, nurse and system-level factors, we seek to uncover whether there are particular combinations of nursing resources, organizational supports and care processes that are most effective in reducing COVID-19 disparities. If our study hypotheses are supported and we can identify characteristics of high performers, it will 1) strengthen the evidence regarding the link between nursing resources and equitable outcomes, and 2) provide a necessary composite and a set of best practices that can be shared with other hospitals. Our proposal is well-aligned with multiple goals of NINR, including dismantling structures that impede health equity, using lessons learned about health disparities from the COVID-19 pandemic and identifying upstream factors that influence health disparities. Collectively, the results of this study will provide the foundation for the next phase of our research, which includes the development of innovative models of care delivery that integrate evidence-based nursing resources and best practices that are associated with equitable outcomes.

项目摘要共同19岁的大流行使长期以来的种族/种族健康不平等进入了国家舞台。黑人和共同19岁的黑人和西班牙裔人的住院和死亡率比他们的白色对应率，引起人们对患者和系统级别因素的关注差异，包括接纳少数族裔患者的医院质量。在这些研究中，很少有能够确定医院的特定特征，这些特征解释了观察到的种族/种族差异结果。我们的研究重点是医院的护士资源的差异，这是一个重要因素在COVID-19分布文献中没有充分解决。在这种混合方法的建议中，我们利用22,000多名新护士收集的行政索赔和独特的调查数据约克和伊利诺伊州的医院，期间大流行期（2021年4月至6月）。我们采用锥形多元匹配是一种新颖的方法，使我们能够仔细控制临床风险和社会因素的差异在少数族裔和白人患者之间，可以清楚地确定COVID-19的结果差异的基础。我们的主要目的是检查护士资源的变化与少数族裔的差异有关 19个结果，包括死亡率和再入院。第二个目标是确定护士和医院 “高性能”医院的特征，在这种医院中最小化了这种差异。识别高后和表现低下的医院，我们将探索成千上万的护士的开放式回应支持社会“脆弱”人群的支持和护理障碍的观点，包括赛车和少数民族。通过检查患者，社区，护士和系统级别的因素，我们试图发现护士资源，组织支持和护理流程的特殊组合最多有效降低COVID-19的差异。如果我们的研究假设得到支持，我们可以确定高性能者的特征，它将1）加强有关护士资源之间联系的证据和公平的结果，以及2）提供必要的综合和一组最佳实践，可以共享与其他医院。我们的建议与尼尔的多个目标相结合，包括拆除结构这阻碍了健康平等，使用有关COVID-19大流行的健康差异的经验教训和确定影响健康分布的上游因素。总的来说，这项研究的结果将提供我们研究的下一阶段的基础，包括开发创新的护理模型交付与公平相关的基于证据的护士资源和最佳实践结果。