Achieving Health Equity During the COVID-19 Pandemic: Lessons Learned from Nurses and High Performing Hospitals

项目摘要 2019冠状病毒病大流行将长期存在的种族/民族健康不平等问题推上了国家舞台。 黑人和西班牙裔COVID-19患者的住院率和死亡率比美国高出2- 3倍。 他们的白色同行的比率，提请注意这些潜在的患者和系统水平因素 差异，包括少数民族患者入住的医院的质量。在这些研究中， 能够确定医院的具体特征，解释观察到的种族/民族差异， 结果。我们的研究重点是不同医院的护理资源的差异，这是一个重要因素， 在COVID-19差异文献中没有得到充分解决。在这个混合方法的建议中，我们 利用行政索赔和独特的调查数据收集超过22,000护士工作在244新 新冠肺炎疫情期间（二零二一年四月至六月），约克及伊利诺伊医院。我们采用锥形多变量 匹配，一种新的方法，使我们能够仔细控制临床风险和社会因素的差异 少数民族和白色患者之间的差异，以明确确定COVID-19结果差异的基础。我们的首要 目的是研究护理资源的变化如何与少数民族COVID的差异相关， 19个结局，包括死亡率和再入院率。第二个目标是确定护理和医院 最大限度地减少这种差异的“高绩效”医院的特点。在确定高和 低绩效医院，我们将探讨开放式的反应，数千名护士谁分享他们的 社会“弱势”群体，包括种族和族裔群体， 少数民族。通过检查患者，社区，护士和系统层面的因素，我们试图揭示是否 护理资源、组织支持和护理过程的特定组合是最重要的。 有效减少COVID-19差异。如果我们的研究假设得到支持， 高绩效者的特征，它将1）加强关于护理资源之间联系的证据 和公平的结果，以及2）提供一个必要的综合和一套可以分享的最佳做法 与其他医院。我们的建议与NINR的多个目标非常一致，包括拆除结构 利用从2019冠状病毒病大流行中吸取的健康差距教训， 确定影响健康差距的上游因素。总的来说，这项研究的结果将提供 为我们下一阶段的研究奠定了基础，其中包括开发创新的护理模式 提供整合循证护理资源和最佳实践，与公平 结果。

Project Summary The COVID-19 pandemic catapulted long-standing racial/ethnic health inequities onto the national stage. Hospitalization and mortality rates for Black and Hispanic individuals with COVID-19 have been 2-3x higher than the rates of their White counterparts, drawing attention to the patient and system level factors underlying these differences, including the quality of hospitals to which minority patients are admitted. Of these studies, few have been able to identify the specific features of hospitals that explain the observed racial/ethnic differences in outcomes. Our study focuses on differences in nursing resources across hospitals, an important factor that has not been adequately addressed in the COVID-19 disparities literature. In this mixed methods proposal, we leverage administrative claims and unique survey data collected from over 22,000 nurses working in 244 New York and Illinois hospitals during the COVID pandemic (April-June 2021). We employ tapered multivariate matching, a novel approach which allows us to carefully control for differences in clinical risk and social factors between minority and white patients to clearly identify the basis of COVID-19 outcome disparities. Our primary objective is to examine how variations in nursing resources were associated with disparities in minority COVID- 19 outcomes, including mortality and readmissions. A second objective is to identify the nursing and hospital characteristics of “high performing” hospitals where such disparities were minimized. After identifying high and low performing hospitals, we will explore the open-ended responses of thousands of nurses who shared their perspectives of supports and barriers to care delivery for socially “vulnerable” populations, including racial and ethnic minorities. By examining patient, community, nurse and system-level factors, we seek to uncover whether there are particular combinations of nursing resources, organizational supports and care processes that are most effective in reducing COVID-19 disparities. If our study hypotheses are supported and we can identify characteristics of high performers, it will 1) strengthen the evidence regarding the link between nursing resources and equitable outcomes, and 2) provide a necessary composite and a set of best practices that can be shared with other hospitals. Our proposal is well-aligned with multiple goals of NINR, including dismantling structures that impede health equity, using lessons learned about health disparities from the COVID-19 pandemic and identifying upstream factors that influence health disparities. Collectively, the results of this study will provide the foundation for the next phase of our research, which includes the development of innovative models of care delivery that integrate evidence-based nursing resources and best practices that are associated with equitable outcomes.