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

医院护理资源与老年结局种族差异的面板研究 在医学研究所发布里程碑式的不平等待遇报告10多年后，种族和民族 对于住院的老年人来说，在昂贵且往往可以预防的不良结果方面仍然存在差异。证据点 这与少数族裔和白人接受护理的医院的差异有关，是差异的一个来源。我们的原创 研究结果表明，护理资源差异(护士人员配备、护士教育和技能水平、 医院和护士工作环境之间的差异可能是导致种族差异的一个重要因素。我们的 然而，到目前为止，工作仅限于横截面数据，使我们无法得出结论 护理资源与差距的关系是因果关系以及干预措施是否需要改善 护理资源将按预期发挥作用。我们在这次续签申请中提出的研究采取了重要的 下一步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 四个大州的成人患者预后评估少数族裔和女性之间的预后差异 白人患者是由少数民族和白人患者的差异造成的，护理资源的差异 少数民族和白人患者接受护理的医院，和/或少数民族和白人患者接受护理的差异 即使在拥有相似护理资源的同一医院接受治疗，患者也会接受治疗。我们做了 有效地利用来自嵌套在 在两个时间点上由600多家医院组成的小组。这提供了一个独特的机会来研究- 已知但鲜为人知的差异来自两个截然不同但互补的优势点。首先，通过 纵观近十年的横截面，我们对个人的作用有了更好的理解 以及组织因素在老年人住院结果差异中的作用。重要的是，我们将了解到 2015年护理与结果差异之间的关联与同一家医院的情况相似 2006年的样本，以及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，关联增加了我们得出关联是因果关系的结论的理由。我们的第二个目标是 检查医院级护理资源随时间的变化，确定这些变化是否与 主要为少数族裔患者服务的医院，并确定结果的变化是否存在差异 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变化。这很重要 了解少数民族服务中护理资源是否改善较少的原因和政策含义 医院。我们将分析的小组数据将使我们能够评估这一点，并确定医院 结果差距是否扩大(或缩小)，以及护理资源的变化是否与这些相关 改变。此外，我们将确定少数族裔服务医院的护理资源变化是否 有助于扩大或缩小白人和少数族裔患者之间的预后差异。更好的因果关系 护理资源和患者结果之间的证据可以刺激基于证据的决策。

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.