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

摘要 美国的孕产妇发病率和死亡率（MMM）存在种族差异，长期以来， 站立，恶化。一名妇女分娩的医院已被确定为这些的驱动因素 结果不佳，以及种族差异。导致这种差异的是医院 不确定。护士为产妇提供大部分直接的病人护理。其他患者 人口，护理资本，支持护士工作的医院资源（例如，工作人员和任务 工作环境），与发病率和死亡率有关，对黑人有不同的有益影响。 与白色相比，患者的结局。不像医院的结构特点，像它的教学 状态或患者急性混合，护理资本是可修改的，并提供了潜在的干预， 改善患者结果和其中的差异。这些发现为 建议对NR 014855（“关于 护理对健康公平性和患者结局的影响”）。本附录的目的是确定 护理资本与MMM之间是否存在关联，以及是否存在差异 为少数种族/族裔妇女提供福利。目标1：确定a 医院的护理资本和MMM的可能性，特别是对少数民族和种族的妇女 组我们假设，更好的护理资本将与整体降低MMM， 少数种族和族裔群体妇女的MMM将有不同程度的下降。 目标2：确定高绩效医院，其中少数民族和族裔群体的妇女 有最低的MMM率，确定是否有医院，特别是高性能 少数群体中的妇女团体。并建立基于证据的医院档案。目标3： 确定护理资本特征区分高绩效和低绩效的程度 医院以及这些特征是否因不同妇女群体而异。为了实现这些目标， 我们建议对来自母研究的第一波数据进行横截面二次分析。护士 通过问卷调查，了解他们医院的组织资源，包括护理 资金、质量和安全。该数据与患者出院摘要和医院数据相结合， 允许我们研究医院组织资源与MMM的妇女协会， 种族/少数民族群体，并确定和描述高绩效的医院。总体 这项工作的目的是不仅要了解护理资本与MMM的关联，或描述高， 但是为了确定护理资本是否像其他病人群体一样， 有可能成为干预措施的目标，对孕产妇成果和公平产生变革性影响。

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.