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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低的医院接受护理，这些医院的健康状况较差患者。几十年来，人们一直在描述棘手的医院结果差异，最近又出现了这种情况随着 COVID-19 死亡率对黑人社区的影响尤为严重，这一问题成为公众关注的焦点。尽管多项研究将结果差异的很大一部分归因于医院的质量差异大部分黑人患者接受治疗的地方（即为黑人服务的医院），人们对此知之甚少哪些可改变的因素导致护理质量较差。该提案从多层次的角度来确定个人、社会和医院决定因素的贡献，以确定可以改变的因素通过“上游”干预措施来实现黑人个人的健康公平。我们假设医院结果的差异在很大程度上是由于可改变的护士资源的不平等医院——为黑人服务的医院护士资源较少。护士资源分布不均是种族歧视的残余，在法律废除种族隔离 50 多年后，该现象继续渗透到医院护理中医院。我们注重护士资源，因为有足够的护理人员可以及时有效地提供服务护理，一个良好的工作环境，护士在实践中拥有临床自主权和强大的跨学科的团队合作、注册护士的技能组合以及高比例的本科毕业生护士和高级执业护士都与更好的患者治疗结果相关，特别是对于少数民族患者。在本研究中，我们评估了医院级别护士资源差异对患者结局，包括院内死亡率和 30 天死亡率、再入院率和住院时间。这对近 250 家医院超过 900,000 名老年患者进行的观察性研究调查 (1) 为黑人服务的医院和其他医院之间护士资源的差异解释了结果的差异； (2) 拥有优质医院护士资源的结果优势是否会得到增强其他医院特征，包括例如医生人员配置、更多的 APRN 数量，或教学医院； (3) 估计患者治疗结果的改善，例如挽救的生命，这可能是如果为黑人服务的医院的护士资源与其他医院相似，这是可以预料的。护士资源有使用近 250 家医院 16,000 多名护士的调查数据进行测量，以描述临床护士资源。使用唯一的医院标识符，护士的反应将与医疗保险相关联患者记录、人口统计和健康指数的社会决定因素。我们的分析方法使用多层次嵌套（层次相关）线性和逻辑回归模型（带有交互项）来完成我们的目标。如果我们的假设得到证实，研究结果将增加证据，为高影响力的可采取行动提供信息 “上游”解决方案旨在消除我们医疗保健系统中普遍存在的种族主义结构性残余利用每家医院现有最丰富的患者护理资源——护士。