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

护理变革对健康公平和患者结果影响的多层次小组研究

• 批准号: 10770894
• 负责人: Matthew D. McHugh
• 金额: $ 22.75万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10770894
• 关键词: Address; Administrative Supplement; Awareness; Birth; Capital; Caring; Cesarean section; Characteristics; Data; Data Sources; Dedications; Developed Countries; Development; Discipline of Nursing; Disparity; Educational process of instructing; Equity; Ethnic Population; Failure; Foundations; Goals; Guidelines; Health Sciences; Hospital Nursing; Hospitalization; Hospitals; Incidence; Inequity; Intervention; Latina; Leadership; Link; Maternal Mortality; Measurable; Medical; Minority Groups; Minority Women; Morbidity - disease rate; Needles; Nurses; Nursing Staff; Operative Surgical Procedures; Outcome; Parents; Patient Discharge; Patient-Focused Outcomes; Patients; Performance; Persons; Physicians; Policies; Population; Pregnancy; Quality of Care; Reduce health disparities; Research; Research Personnel; Resources; Risk; Risk Factors; Safety; Strategic Planning; Surveys; United States; United States National Institutes of Health; Variant; Woman; Women' s Group; Women' s Health; Work; black patient; black women; direct patient care; ethnic minority; ethnic minority population; evidence base; experience; health disparity populations; health equity; hospital organization; hospital readmission; improved; improved outcome; informant; maternal morbidity; maternal outcome; member; mortality; outcome disparities; parent grant; patient population; professional atmosphere; racial disparity; racial minority; racial minority population; secondary analysis; severe maternal morbidity; sociodemographics; standardized care

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.

抽象的 美国的孕产妇发病率和死亡率 (MMM) 具有种族差异、长期 站立，并且恶化。一名妇女分娩的医院已被确定为这些事件的肇事者 不良的结果以及其中的种族差异。医院的什么原因导致了这种差异 不确定。护士为产妇提供大部分直接的病人护理。在其他病人身上 人口、护理资本、支持护士工作的医院资源（例如人员配备和 工作环境），与发病率和死亡率相关，并对黑人产生不同的有益影响 与怀特相比，患者的结果。不像医院的结构特点，就像它的教学 状态或患者的敏锐度组合，护理资本是可以修改的，并提供潜在的干预措施 改善患者的治疗结果和其中的差异。这些发现为 拟议对 NR014855 进行行政补充（“关于变化影响的多级小组研究”） 护理对健康公平和患者结果的影响”）。本补充材料的目的是确定 护理资本与 MMM 之间是否存在关联，以及是否存在差异 少数种族/族裔妇女受益。目标 1：确定 a 之间的关联 医院的护理资本和 MMM 的几率，特别是对于来自少数种族和民族的女性 组。我们假设更好的护理资本将与整体 MMM 和 来自少数种族和族裔群体的女性的 MMM 将会出现差异性下降。 目标 2：确定高绩效医院，其中来自少数种族和族裔群体的妇女 MMM 率最低，确定是否有在特定领域表现出色的医院 来自少数群体的妇女群体。并建立基于证据的医院概况。目标 3： 确定护理资本特征区分高绩效和低绩效的程度 医院以及这些特征对于不同的女性群体是否有所不同。为了实现这些目标， 我们建议对母研究的第一波数据进行横断面二次分析。护士 通过调查作为信息提供者了解其医院的组织资源，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 让我们检查医院组织资源与 MMM 之间的关系 种族/族裔群体，并确定和描述高绩效医院。首要的 这项工作的目的不仅是了解护理资本与 MMM 的关系，或者描述高 执行医院，但要确定护理资本是否像其他患者群体一样拥有 有可能成为干预措施的目标，对孕产妇结局和公平产生变革性影响。