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

院内心脏骤停护理结果和过程的差异：护理组织和实施差异的作用

• 批准号: 9470983
• 负责人: JACQUELINE MARGO BROOKS CARTHON
• 金额: $ 37.44万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-26 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9470983
• 关键词: Accountability; Acute; Affect; American Heart Association; Blood Circulation; Care given by nurses; Caring; Case Mixes; Cessation of life; Characteristics; Chest; Clinical; Data; Data Set; Databases; Discipline of Nursing; Electric Countershock; Elements; Emergency response; Environment; Event; Funding; Goals; Guidelines; Heart Arrest; Hospital Mortality; Hospital Nursing; Hospitals; Hour; Impairment; Institute of Medicine (U.S.); Institution; International; Intervention; Knowledge; Life; Link; Measures; Minority; Minority-Serving Institution; Monitor; Nervous System Physiology; Neurologic; Neurological outcome; Nurses; Nursing Education; Nursing Process; Nursing Staff; Outcome; Patient-Focused Outcomes; Patients; Patterns of Care; Play; Process; Provider; Quality of Care; Race; Reaction Time; Recommendation; Registries; Reporting; Research; Resources; Resuscitation; Role; Sampling; Surveys; Survival Rate; Survivors; System; Time; Variant; Work; Workload; burden of illness; care delivery; clinical care; clinical practice; collaborative environment; data registry; experience; functional disability; improved; individual patient; nursing skill; patient registry; prevent; racial disparity; response; skills; trend

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.

项目摘要 院内心脏骤停（IHCA）代表灾难性的，通常是最终事件，最多影响70万 每年患者。尽管发生心脏骤停时有资源和机会，但很少 比四分之一的患者生存为出院，并且在机构和种族之间存在显着的生存差异。 尤其是黑人患者，生存率和更明显的神经系统的几率下降了12％ 心脏骤停后功能障碍。心脏骤停结果的差异在很大程度上归因于 少数民族获得护理的机构的质量差距。在这些方面的护理过程中的变化 设置表明，黑人获得护理的医院的能力可能有根本不同 检测并防止死亡并严重衰弱。我们的研究将检查机构机制 通过对前线护理提供者的重点检查IHCA差异的根本差异。在医院，护士 是主要的临床监视系统，并且在紧急情况的主动性和交付中起着不可或缺的作用 回答。护士每天24小时在床边；他们负责预警系统 监视；他们直接了解患者状况和状况变化，并且通常是第一个 在心脏骤停现场。护士对患者急性变化做出适当反应的能力 身份与护士组织因素有关，包括护士人员配备，护士教育，护士技能 混合和护士工作环境。护士组织与少数族裔IHCA之间的关系 但是，结果尚不清楚。我们肯定护士在IHCA中扮演着重要但持续不断的角色 患者的结果以及整个医院的护士的差异可能有助于解释IHCA结果差异。到 检查这种关系，我们利用了多个大型和独特的数据库：美国心脏 协会通过指南 - 激发（GWTG-R）临床注册表和忍者资助 RN4Cast-US研究（R01-NR004513和R01-NR014855）。临床注册表均匀合并 报告并精确定义了由国际专家开发的临床变量。使用独特的医院 标识符将患者结局与RN4cast-US的护理护理量度联系起来，我们将确定特定的， 影响少数IHCA患者结果的护士的可行元素。我们将要的数据集 组装包括2006年和2015年收集的护士调查数据。 在同一大型医院样本中，成千上万的患者使我们能够检查趋势和关系 在护士和少数族裔IHCA的结果之间，并确定它们是否随着时间而变化。知道这些是否 尽管患者病例混合和敏锐度以及护士的变化，但关联是稳定且持久的 在某些医院中可能比其他医院更大的特征将提供更有力的证据表明 关联是持久的，我们的结果是可以推广的。