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

项目摘要 新冠肺炎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。 患有新冠肺炎的黑人和西班牙裔患者的住院率和死亡率是 他们的白人同行的比率，提请注意患者和系统层面的因素 差异，包括少数族裔患者所住医院的质量。在这些研究中，很少有人 能够确定医院的具体特征，解释在 结果。我们的研究重点是不同医院之间护理资源的差异，这是一个重要的因素 在新冠肺炎的差异文献中没有得到充分的解决。在这个混合方法提案中，我们 利用从244个新区22,000多名护士收集的行政索赔和独特的调查数据 在COVID大流行期间(2021年4月至6月)纽约和伊利诺伊州的医院。我们采用渐进式多变量 配对，一种新的方法，允许我们仔细控制临床风险和社会因素的差异 以明确少数族裔和白人患者之间新冠肺炎结局差异的基础。我们的初选 目的是研究护理资源的差异如何与少数民族COVID的差异有关。 19个结果，包括死亡率和重新入院。第二个目标是确定护理和医院 这是“高绩效”医院的特点，在这些医院中，这种差异被最小化。在确定高和 表现不佳的医院，我们将探讨数千名护士的开放式回应，他们分享了他们的 对社会“弱势”人群提供护理的支持和障碍的观点，包括种族和 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 护理资源、组织支持和护理流程的特定组合是最 --有效缩小新冠肺炎差距。如果我们的研究假设得到支持，我们可以确定 高绩效人员的特点，它将1)加强关于护理资源之间联系的证据 和2)提供必要的综合办法和一套可供分享的最佳做法 与其他医院合作。我们的建议与NINR的多个目标很好地结合在一起，包括拆除结构 这阻碍了卫生公平，利用从新冠肺炎大流行和 确定影响健康差距的上游因素。总而言之，这项研究的结果将提供 为我们下一阶段的研究奠定基础，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.