Disparities in the Outcomes and Processes of Care for In-Hospital Cardiac Arrest: The Role of Differences in the Organization and Delivery of Nursing

项目摘要 院内心脏骤停（IHCA）是灾难性的，通常是终末事件，影响多达70万人 患者每年尽管有资源和机会在心脏骤停发生时进行早期干预， 超过四分之一的患者存活到出院，不同机构和种族的存活率差异很大。 特别是黑人患者，其生存率降低了12%，神经系统和 心脏骤停后的功能障碍。心脏骤停结局的差异主要归因于 少数群体接受照料的机构存在质量差距。这些国家的护理提供过程存在差异 环境表明，黑人接受护理的医院在他们的能力方面可能有根本的不同， 检测和预防死亡和严重衰弱。我们的研究将审查体制机制 通过对一线护理提供者的重点检查，了解潜在的IHCA差异。在医院里，护士 是主要的临床监测系统，在启动和提供紧急情况方面发挥着不可或缺的作用。 应答护士24小时守在床边;他们负责预警系统 监测;他们直接了解病人的病情和病情变化，往往是第一个 心脏骤停的现场护士对病人病情变化作出适当反应的能力 护理组织因素包括护理人员配置、护理教育、护理技能 混合，和护士的工作环境。护理组织与少数民族IHCA的关系 然而，结果尚不清楚。我们认为，护士在IHCA中发挥着重要的作用， 病人的结果，以及不同医院的护理差异可能有助于解释IHCA结果的差异。到 研究这种关系，我们利用多个大型和独特的数据库：美国心脏 协会的获得与指南复苏（GWTG-R）临床登记和NINR资助的 RN 4CAST-US研究（R 01-NR 004513和R 01-NR 014855）。临床注册中心统一纳入 报告和精确定义的国际专家开发的临床变量。使用独特的医院 标识符将患者结果与RN 4CAST-US的护理措施联系起来，我们将识别特定的， 影响少数IHCA患者结局的护理可操作要素。我们将收集的数据 汇编包括2006年和2015年收集的护士调查数据。使用几十个独立的横截面 成千上万的病人在同一大样本的医院，使我们能够检查趋势和关系， 护理和少数民族IHCA结果之间的关系，并确定它们是否随时间而变化。知道这些 尽管患者的病例组合和急性程度以及护理发生了变化，但相关性是稳定和持久的。 在某些医院可能比其他医院更大的特征，将提供更有力的证据， 关联是持久的，我们的结果是可推广的。

Project Summary In-hospital cardiac arrests (IHCA) represent catastrophic, often terminal events and affect up to 700,000 patients annually. Despite the resources and opportunity to intervene early when cardiac arrests occur, fewer than a quarter of patients survive to discharge, and survival varies significantly across institutions and by race. Black patients, in particular, experience up to 12% lower odds of survival and more pronounced neurologic and functional impairment following a cardiac arrest. Disparities in cardiac arrest outcomes are largely attributed to quality gaps at the institutions where minorities receive care. Variations in the process of care delivery in these settings suggests that hospitals where Blacks receive care may be fundamentally different in their ability to detect and prevent death and significant debilitation. Our study will examine institutional mechanisms underlying IHCA disparities through a focused examination of front line care providers. In the hospital, nurses are the primary clinical surveillance system and play an integral role in the initiation and delivery of emergency responses. Nurses are at the bedside 24 hours a day; they are responsible for early warning system monitoring; they have direct knowledge of patient conditions and changes in conditions and are often the first on the scene of a cardiac arrest. The ability for nurses to respond appropriately to acute changes in patient status has been linked to nursing organizational factors, including nurse staffing, nurse education, nursing skill mix, and the nurse work environment. The relationship between the organization of nursing and minority IHCA outcomes, however, is unknown. We posit that nurses play a significant, yet underexplored, role in IHCA patient outcomes, and that variation in nursing across hospitals may help explain IHCA outcome disparities. To examine this relationship, we take advantage of multiple large and unique databases: The American Heart Association's Get with the Guidelines–Resuscitation (GWTG-R) clinical registry and the NINR-funded RN4CAST-US studies (R01-NR004513 and R01-NR014855). The clinical registry incorporates uniformly reported and precisely defined clinical variables developed by international experts. Using unique hospital identifiers to link patient outcomes with measures of nursing care from RN4CAST-US, we will identify specific, actionable elements of nursing that influence minority IHCA patient outcomes. The data set that we will assemble includes nurse survey data collected in 2006 and 2015. Using independent cross-sections of tens of thousands of patients in the same large sample of hospitals, enables us to examine trends and relationships between nursing and minority IHCA outcomes and determine if they vary over time. Knowing whether these associations are stable and enduring, in spite of changes in both patient case-mix and acuity and in the nursing characteristics that may be greater in some hospitals than others, will provide stronger evidence that the associations are persistent and that our results are generalizable.