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追踪研究 自医学研究所具有里程碑意义的不平等待遇报告发表以来， 住院的老年人在费用昂贵而且往往可以预防的不良结果方面仍然存在差异。证据表明 少数民族和白人在医院接受护理的差异是不平等的根源。我们原来的 研究结果表明，护理资源的差异（护理人员配备，护士的教育和技能水平， 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 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， 护理资源与差距是因果关系，是否采取干预措施，以改善 护理资源将按预期发挥作用。我们在这次更新申请中提出的研究 下一个步骤是通过使用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结局，以评估少数民族和 白色病人的原因是少数民族和白色病人之间的差异， 少数民族和白色患者接受治疗的医院，和/或少数民族和白色患者在治疗方面的差异 即使病人是在同一家医院接受治疗，而且有类似的护理资源。我们做出 有效利用现有数据，这些数据来自嵌套在一个 超过600家医院在两个时间点的小组。这提供了一个独特的机会，以检查好- 从两个不同但互补的有利位置了解已知但知之甚少的差异。一是通过 通过对近十年的横截面的研究，我们对个人的作用有了更好的理解。 和组织因素在老年人医院结果的差异。重要的是，我们将了解 2015年护理和结果差异之间的关联与同一医院的相似 2006年的样本，以及它们是否对白人和少数民族有不同。支持稳定性的证据 随着时间的推移，联系增加了我们得出联系是因果关系的结论的理由。我们的第二个目标是 检查医院一级护理资源随时间的变化，确定这些变化是否与 主要为少数民族患者服务的医院，并确定结果差异的变化 少数民族和白色病人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。重要的是 为了解少数民族服务中护理资源改善较少的原因和政策含义 医院的我们将分析的面板数据将使我们能够评估这一点，并确定医院是否 结果差异增加（或缩小），以及护理资源的变化是否与这些 变化此外，我们将确定少数民族服务医院的护理资源变化是否 有助于扩大或减少白色和少数民族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.