Culture of Patient Safety in Black Serving and Non-Black Serving Hospitals

黑人服务和非黑人服务医院的患者安全文化

• 批准号: 10774362
• 负责人: Denise D. Quigley
• 金额: $ 40万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10774362
• 关键词: Culture; Patient; Safety; Black; Serving

PROJECT SUMMARY/ABSTRACT Patient safety events are an important leading cause of morbidity and mortality globally; harm from patient safety events can be an important driver of health disparities. Black patients are at increased risk of patient safety events compared to White patients. Black patients also receive care at lower quality hospitals than White patients. In part this is due to the fact that in the US, hospital care is highly segregated with 25% of hospitals caring for 90% of elderly Black patients. Hospitals that care for a high proportion of Black patients are known as Black serving hospitals. Black serving hospitals perform worse on several Agency for Healthcare Research Quality (AHRQ) patient safety indicators including those at the individual-provider level, surgical related events, and hospital resource-dependent events. While higher patient safety events in Black serving hospitals is likely due to several factors, one area of research that has not been conducted is examining the differences in the culture of safety in Black serving versus non-Black serving hospitals. Evidence indicates that health systems with a robust patient safety culture have fewer adverse safety events. Disparities in patient safety culture may contribute to such inequities in patient safety in Black and non-Black serving hospitals. Given these gaps, we propose in response to AHRQ’s Special Emphasis Notice for Health Services Research to Advance Health Equity a mixed-methods study guided by Donabedian’s Quality Framework and the National Institute on Minority Health and Health Disparities Research Framework with the aims to: 1) Identify and compare patterns in patient safety culture for Black and non-Black serving hospitals; 2) Examine associations of patient safety culture with financial resources and with patient safety outcomes in Black and non-Black serving hospitals; and 3) Describe perceived facilitators and barriers that contribute to organizational support and promotion of patient safety and identify best patient safety practices for diverse settings. In Aim 1, we will use de-identified data from AHRQ’s Hospital Survey on Patient Safety Culture (HSOPS) to compare patient safety culture in Black and non-Black serving hospitals. In Aim 2, we will link Medicare, American Hospital Association, and other publicly available hospital characteristics datasets to identified HSOPS data to examine the association of patient safety culture with patient safety events (PSEs) and identify other factors associated with disparities in HSOPS and PSEs. In Aim 3, we will conduct group interviews with hospital leaders (financial executive, clinician, patient safety officer) in Black and non-Black serving hospitals to identify facilitators and barriers to effective patient safety culture practices and strategies to improve patient safety. Our work will identify root causes of disparities in patient safety, explore differences in barriers to health equity, and highlight best patient safety practices to improve hospital care quality and reduce health inequities as well as engage with key stakeholders to accelerate dissemination of these best practices in Black serving and non- Black serving hospitals with the ultimate aim of reducing morbidity and mortality of hospitalized Black patients.

项目总结/摘要 患者安全性事件是全球发病率和死亡率的重要主要原因;来自患者的伤害 安全事件可能是健康差距的一个重要驱动因素。黑人患者的患病风险增加 与白色患者相比的安全性事件。黑人病人也在质量较低的医院接受治疗， 白色病人。部分原因是，在美国，医院护理是高度隔离的，25%的 医院照顾90%的老年黑人病人。照顾黑人病人比例高的医院 被称为黑人服务医院黑人服务医院在几个医疗保健机构中表现更差 研究质量（AHRQ）患者安全指标，包括个人提供者层面的指标、手术指标 相关事件和医院资源依赖事件。虽然黑人服务的患者安全事件更高， 医院可能是由于几个因素，一个尚未进行的研究领域是检查 黑人服务与非黑人服务医院的安全文化差异。证据表明 具有健全的患者安全文化的卫生系统较少发生不良安全事件。患者差异 安全文化可能导致黑人和非黑人服务医院的病人安全不平等。 鉴于这些差距，我们建议在回应AHRQ的特别强调通知卫生服务， 促进健康公平的研究是一项由Donabedian质量框架指导的混合方法研究， 国家少数民族健康和健康差异研究框架研究所，目的是：1） 确定和比较黑人和非黑人服务医院的患者安全文化模式; 2）检查 患者安全文化与财务资源和患者安全结果的关联， 非黑人服务的医院;和3）描述感知的促进者和障碍，有助于组织 支持和促进患者安全，并确定不同环境下的最佳患者安全实践。在目标1中， 我们将使用来自AHRQ医院患者安全文化调查（HSOPS）的去识别数据进行比较 黑人和非黑人服务医院的患者安全文化。在目标2中，我们将把医疗保险、美国人 医院协会和其他公开可用的医院特征数据集，以确定HSOPS数据， 检查患者安全文化与患者安全事件（PSE）的关联并确定其他因素 与HSOPS和PSE中的差异相关。在目标3中，我们将与医院进行小组访谈， 黑人和非黑人服务医院的领导人（财务主管、临床医生、患者安全官员）， 促进者和障碍，有效的病人安全文化的做法和战略，以提高病人的安全。我们 工作将确定患者安全差异的根本原因，探索健康公平障碍的差异， 强调最佳患者安全实践，以提高医院护理质量，减少健康不平等，以及 与主要利益相关者合作，加快在黑人服务和非黑人服务中传播这些最佳做法。 为黑人服务的医院，最终目的是降低住院黑人病人的发病率和死亡率。