Multilevel Panel Study of Effects of Changes in Nursing on Health Equity and Patient Outcomes

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Abstract Maternal morbidity and mortality (MMM) rates in the U.S. are marked by racial disparities, long- standing, and worsening. The hospital where a woman gives birth has been identified as a driver of these poor outcomes, and the racial disparities therein. What it is about hospitals that leads to this variation has not certain. Nurses provide most of the direct patient care for birthing women. In other patient populations, nursing capital, the hospital resources which support nurses' work (e.g., staffing and the work environment), is linked to morbidity and mortality and has a differential beneficial effect for Black patients' outcomes, compared to White. Unlike a hospital's structural characteristics, like its teaching status or patient acuity mix, nursing capital is modifiable and provides a potential intervention for improving patient outcomes and disparities therein. These findings provide the foundation for the proposed administrative supplement to NR014855 (“Multilevel Panel Study of Effects of Changes in Nursing on Health Equity and Patient Outcomes”). The purpose of this supplement is to determine whether there is an association between nursing capital and MMM, and whether there is a differentially benefit for women from racial/ethnic minorities. Aim 1: To determine the association between a hospital's nursing capital and the odds of MMM, especially for women from minoritized racial and ethnic groups. We hypothesize that better nursing capital will be associated with overall decreased MMM and that there will be a differential decrease in MMM for women from minoritized racial and ethnic groups. Aim 2: To identify high-performing hospitals, where women from minoritized racial and ethnic groups have the lowest rates of MMM, determine if there are hospitals that are high performing for particular groups of women from minoritized groups. and develop evidence-based profiles of hospitals. Aim 3: To determine the degree to which the nursing capital characteristics distinguish high from low-performing hospitals and whether these characteristics vary for different groups of women. To accomplish these aims, we propose a cross-sectional secondary analysis of the first wave of data from the parent study. Nurses serve as informants, via a survey, about their hospital's organizational resources, including nursing capital, quality, and safety. This data is combined with patient discharge abstracts and hospital data to allow us to examine the association of hospital organizational resources with MMM for women from racial/ethnic minority groups and to identify and describe high-performing hospitals. The overarching aim of this work is to not only understand the association of nursing capital with MMM, or describe high- performing hospitals, but to determine whether – as in other patient populations – nursing capital has the potential to be a target for intervention to have a transformative effect on maternal outcomes and equity.