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

摘要 在美国，孕产妇发病率和死亡率(MMM)以种族差异为标志，长期以来， 站立着，而且还在恶化。一名妇女分娩的医院已被确定为这些疾病的驱动因素 糟糕的结果，以及其中的种族差距。导致这种差异的是医院的什么 不确定。护士为分娩妇女提供了大部分直接的病人护理。在其他患者中 人口、护理资本、支持护士工作的医院资源(例如，人员配置和 工作环境)，与发病率和死亡率有关，对黑人有不同的益处 与怀特相比，患者的结果。与医院的结构特点不同，比如它的教学 状态或患者敏锐度组合，护理资本是可修改的，并提供潜在的干预措施 改善患者的结果和其中的差异。这些发现为研究提供了基础 对NR014855的拟议行政补编(“关于#年变化的影响的多级别小组研究 关于健康公平和患者结果的护理“)。本附录的目的是确定 护理资本与MMM之间是否存在关联，是否存在差异 使少数族裔妇女受益。目标1：确定 医院的护理资本和MMM的几率，特别是来自少数族裔和民族的妇女 组。我们假设，更好的护理资本将与总体MMM和 来自少数种族和族裔群体的妇女的MMM将有不同程度的下降。 目标2：确定高绩效的医院，在那里，来自少数族裔和族裔群体的妇女 MMM的比率最低，确定是否有特别高绩效的医院 来自小规模团体的妇女团体。并制定以证据为基础的医院概况。目标3：实现 确定护理资本特征区分高绩效和低绩效的程度 以及这些特征是否因不同的妇女群体而有所不同。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断面二次分析。护士 通过调查，提供有关医院组织资源的信息，包括护理 资本、质量和安全。这些数据与患者出院摘要和医院数据相结合，以 允许我们检查医院组织资源与女性MMM之间的关联 对种族/少数民族群体进行宣传，确定和描述高水平的医院。最重要的是 这项工作的目的是不仅要了解护理资本与MMM的关联，或者描述高护理资本与MMM之间的关系。 但要确定护理资本是否像其他患者群体一样具有 有可能成为干预措施的目标，对孕产妇结果和公平产生变革性的影响。

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.