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Differences in Hospital Nursing Resources among Black-Serving Hospitals as a Driver of Patient Outcomes Disparities

黑人服务医院之间医院护理资源的差异是患者结果差异的驱动因素

基本信息

批准号：
10633905
负责人：
Karen Blanchette Lasater
金额：
$ 40.63万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10633905
关键词：
Academy Accounting Address Admission activity Advanced Practice Nurse Advocate Affect Age Attention Beds Black American Black Populations Black race COVID-19 mortality COVID-19 pandemic Caring Characteristics Clinical Clinical Nursing Communities Comprehensive Health Care Data Decision Making Desegregation Diagnosis Discipline of Nursing Disparity Educational process of instructing Elderly Family Floor Fostering Goals Healthcare Healthcare Systems Hospital Nursing Hospitalists Hospitalization Hospitals Individual Inequity Infrastructure Intervention Investments Legal Length of Stay Linear Regressions Link Logistic Regressions Measures Medical Medicare Medicine Modeling New York City Nurse&apos s Role Nurses Nursing Staff Observational Study Operative Surgical Procedures Outcome Patient Care Patient-Focused Outcomes Patients Physicians Policies Quality of Care Racial Segregation Records Registered nurse Reporting Research Resources Severity of illness Surveys Teaching Hospitals Technology Translational Research Urban Hospitals black patient care outcomes comorbidity coronavirus disease disparity reduction fortification health determinants health equity hospital care hospital readmission improved improved outcome indexing minority patient mortality novel strategies outcome disparities poor health outcome professional atmosphere racial disparity racial health disparity racial minority racism recruit response sex skills social social health determinants

项目摘要

Black Americans are more likely to receive care in lower quality hospitals that confer worse health outcomes to patients. The intractable hospital outcomes disparities have been described for decades and most recently came to the forefront of public attention with COVID-19 mortality disproportionally affecting Black communities. Despite multiple studies which attribute a large share of outcome disparities to quality differences in hospitals where significant proportions of Black patients are treated (i.e., Black-serving hospitals), little is known about what modifiable factors underlie the poorer quality care. This proposal takes a multilevel perspective to identify the contributions of individual, social, and hospital determinants to identify modifiable factors that can be targeted through `upstream' interventions to achieve health equity for Black individuals. We hypothesize that disparities in hospital outcomes are due, in large part, to inequities in the modifiable nurse resources of hospitals—with fewer nurse resources in Black-serving hospitals. This uneven distribution of nurse resources is a vestige of racism that continues to pervade hospital care more than 50 years after the legal desegregation of hospitals. We focus on nurse resources, since having enough nursing staff to deliver timely and effective care, a favorable work environment in which nurses have clinical autonomy in their practice and strong interdisciplinary teamwork, a skill mix rich in registered nurses, and high proportions of bachelors-prepared nurses and advanced practice nurses, have all been associated with better patient outcomes, particularly for minority patients. In this study, we evaluate the impact of hospital-level differences in nurse resources on patient outcomes, including in-hospital and 30-day mortality, readmission, and hospital length of stay. This observational study of over 900,000 older adult patients in nearly 250 hospitals investigates (1) whether differences in nurse resources between Black-serving and other hospitals explain outcomes disparities; (2) whether the outcomes-advantages of having superior hospital nurse resources are enhanced in the presence of other hospital characteristics, including for example, physician staffing, greater numbers of APRNs, or teaching hospitals; and (3) estimates the improvements in patient outcomes, such as lives saved, that could be expected if nurse resources in Black-serving hospitals were similar to other hospitals. Nurse resources are measured using survey data from over 16,000 nurses in nearly 250 hospitals to describe multiple aspects of the clinical nurse resources. Using a unique hospital identifier, nurse responses will be linked with Medicare patient records, demographic and social determinant of health indices. Our analytic approach uses multi-level nested (hierarchically-related) linear and logistic regression models (with interaction terms) to accomplish our aims. If our hypotheses are confirmed, the findings will add evidence to inform high-impact actionable `upstream' solutions to dismantle structural remnants of racism that pervade our healthcare system, by leveraging the most abundant patient care resource already existing in every hospital—nurses.

美国黑人更有可能在质量较差的医院接受治疗，这些医院给他们带来的健康结果更差