Multilevel Panel Study of Effects of Changes in Nursing on Health Equity and Patient Outcomes

护理变革对健康公平和患者结果影响的多层次小组研究

• 批准号: 10599321
• 负责人: Matthew D. McHugh
• 金额: $ 79.34万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10599321
• 关键词: Academy; Adherence; Age; Attention; Authorization documentation; Back; COVID-19; COVID-19 pandemic; Care given by nurses; Caring; Clinical; Clinical Nursing; Clinical Protocols; Clinical Trials; Community Healthcare; Complex; Data; Data Collection; Data Set; Decision Making; Discipline of Nursing; Disparity; Education; Electronics; Ensure; Environment; Equity; Ethnic Origin; Evaluation; Event; Fostering; Frail Elderly; Funding; Health; Healthcare; Hospitals; Intervention; Investments; Knowledge; Link; Measurement; Measures; Medicine; Methods; Minority; Nature; Nurse' s Role; Nurses; Nursing Education; Nursing Homes; Nursing Staff; Organizational Change; Organizational Innovation; Outcome; Ownership; Pathway interactions; Patient Care; Patient-Focused Outcomes; Patients; Personal Satisfaction; Play; Policies; Policy Making; Population; Protocols documentation; Quality of Care; Race; Recommendation; Research; Resources; Risk Factors; Sampling; Sepsis; Surveys; Time; Translating; Trust; Work; authority; burnout; care costs; care delivery; care outcomes; clinical care; cost; demographics; design; ethnic disparity; ethnic health disparity; ethnic minority; evidence base; experience; falls; health care service organization; health disparity; health equity; improved; improved outcome; innovation; interest; longitudinal analysis; longitudinal design; minority patient; multiple chronic conditions; outcome disparities; patient population; primary care practice; professional atmosphere; programs; racial disparity; racial health disparity; racial minority; response; safety net; trend

The organizational context in which nursing care is delivered plays a key role in health outcomes for patients. Through our NINR-sponsored program of research, continually funded since inception, we have produced vital information from large and representative samples of organizations (e.g., hospitals, nursing homes, primary care practices) on the impact of the context of nursing care on patient outcomes, health disparities, and nurse well-being. The modifiable features of interest include ensuring sufficient nurse staffing and resources, investing in nurse education, trusting nurses' autonomy to make informed clinical decisions and act, fostering interprofessional teamwork and respect, and involving frontline nurses in policy and decision-making. We conducted large-scale surveys of nurses in 1999, 2006, 2016, 2020, and 2021, aggregating their responses to produce organization-level nursing measures, as well as indicators of nurse outcomes (e.g., burnout) that we link with clinical outcomes data from patients in the same organizations. The majority of the work was cross- sectional, and while suggestive, falls short of providing the confidence needed to translate evidence into major policy and practice reforms. Our last renewal application enlarged the measurement and analytic frame to longitudinal analyses of organizational changes and outcomes at two points in time in 4 states. In this renewal, we will significantly extend and expand this work to enable replication of our data collection effort twice within the study period in 7 states (CA, FL, IL, NJ, NM, NY, PA), creating a unique panel dataset of organizations, the nurses working there, and the patients they care for, going as far back as 1999. We leverage a new partnership to substantially reduce the cost of data collection and add states that allow for new questions about the differential impact of nursing changes for various populations. The design emphasizes evaluation of factors inducing change in nursing practice, distinguishing the impact of the active and intentional, e.g., Magnet recognition, policies like staffing ratios, from the environmental and historical, e.g., COVID-19 pandemic, hospital consolidation trends, on outcomes for patients of all ages, risk factors, and demographics. Our aims are: 1) to determine whether there are sustainable effects of organizational change on nursing practice and associated patient outcomes and cost across a range of patient populations and settings; 2) to determine whether organizational nursing changes over time diminish health disparities and if the changes and their effects differ in minority-serving and/or safety-net organizations; and 3) to examine if nursing-related policy interventions (e.g., nurse-to-patient ratios [CA], staffing committees [NY]) and organizational innovations (e.g., Magnet/Pathway) aimed at improving outcomes through work environment reform had a sustained impact over time and in the face of challenges like COVID-19. The overarching aim is to not just understand the benefits of organizational change for patient outcomes, but to understand how to target organizational change via intervention that can have a transformative impact on health equity, nurse wellbeing, and patient outcomes.

提供护理服务的组织环境对于患者的健康结果起着关键作用。 通过 NINR 资助的研究计划（自成立以来不断资助），我们已经取得了重要成果 来自大型且有代表性的组织样本的信息（例如医院、疗养院、初级 护理实践）研究护理环境对患者结果、健康差异和护士的影响 福利。感兴趣的可修改特征包括确保足够的护士人员和资源， 投资于护士教育，相信护士有自主权做出明智的临床决策和行动，培养 跨专业团队合作和尊重，并让一线护士参与政策和决策。我们 于 1999 年、2006 年、2016 年、2020 年和 2021 年对护士进行了大规模调查，汇总了他们的答复 制定组织层面的护理措施以及护士结果指标（例如，倦怠） 与同一组织中患者的临床结果数据相链接。大部分工作是交叉的 分段的，虽然具有启发性，但不足以提供将证据转化为主要证据所需的信心 政策和实践改革。我们上次的更新应用程序扩大了测量和分析框架 对 4 个州两个时间点的组织变革和结果进行纵向分析。在这次更新中， 我们将显着扩展这项工作，以便能够在短时间内复制我们的数据收集工作两次 研究期间在 7 个州（加利福尼亚州、佛罗里达州、伊利诺伊州、新泽西州、新墨西哥州、纽约州、宾夕法尼亚州）创建了一个独特的组织面板数据集， 早在 1999 年，我们就在那里工作的护士以及他们所照顾的患者。我们利用了一种新的 伙伴关系，以大幅降低数据收集成本，并添加允许提出新问题的国家 护理变化对不同人群的不同影响。设计强调因素评估 引起护理实践的变化，区分主动和有意的影响，例如磁铁 来自环境和历史的认可、人员配置比例等政策，例如 COVID-19 大流行， 医院整合趋势，涉及所有年龄段患者的结果、风险因素和人口统计数据。我们的目标 是： 1) 确定组织变革是否对护理实践有可持续的影响； 不同患者群体和环境下的相关患者治疗结果和费用； 2）确定 组织护理的变化是否会随着时间的推移而减少健康差异，以及这些变化及其效果是否 服务于少数群体和/或安全网组织的影响有所不同； 3）检查护理相关政策是否 干预措施（例如，护士与患者的比例[CA]、人员配备委员会[NY]）和组织创新（例如， Magnet/Pathway）旨在通过工作环境改革改善成果，对 时间和面对像 COVID-19 这样的挑战。总体目标不仅仅是了解 组织变革的目的是为了患者的结果，但要了解如何通过以下方式来实现组织变革： 可以对健康公平、护士福祉和患者治疗结果产生变革性影响的干预措施。