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

在 COVID-19 大流行期间实现健康公平：从护士和高绩效医院汲取的经验教训

基本信息

批准号：
10655888
负责人：
JACQUELINE MARGO BROOKS CARTHON
金额：
$ 40.63万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-03-27 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10655888
关键词：
Accounting Address Attention Black Populations Black race COVID-19 COVID-19 disparity COVID-19 health disparity COVID-19 mortality COVID-19 pandemic Caring Characteristics Chronic Disease Communities Data Development Disadvantaged minority Discipline of Nursing Disparity Ensure Equity Ethnic Origin Evaluation Foundations Goals Health Insurance Hispanic Hispanic Populations Hospitalization Hospitals Illinois Individual Inequity Intervention Learning Link Literature Methods Minority National Institute of Nursing Research New York Nurses Nursing Research Nursing Staff Outcome Patient Admission Patient-Focused Outcomes Patients Perception Persons Phase Population Heterogeneity Primary Care Physician Process Race Registered nurse Research Resources Respondent Risk Factors Service delivery model Socioeconomic Factors Structure Surveys System Systems Development United States Variant Vulnerable Populations Work acute care barrier to care black patient burden of illness care delivery classification trees clinical care clinical risk community-level factor disparity reduction ethnic difference ethnic minority evidence base experience health care quality health disparity health equity health inequalities hospital care hospital readmission improved innovation minority patient mortality novel strategies nursing care quality outcome disparities pandemic disease professional atmosphere racial difference racial minority regression trees response social factors social vulnerability sociodemographic factors

项目摘要

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.

项目总结