Worse Nursing-Sensitive Indicators in Black-serving Hospitals.

Abstract

Background: In hospitals that serve disproportionately patients of black race, here termed Black-serving hospitals, nurse staffing is worse, mortality rates are higher, and nursing-sensitive indicators may be worse than in other hospitals, but this evidence has not been compiled.

Objective: The study objective was to examine whether nursing-sensitive indicators, which measure changes in patient health status directly affected by nursing care, differ in hospitals where Black patients predominantly access their care, as compared to other hospitals.

Methods: To fulfill the objective, a cross-sectional design using publicly available 2019 to 2022 Hospital Compare and 2019 Medicare Provider Analysis and Review (MEDPAR) and Case Mix Index file databases was used. Four nursing-sensitive indicators were evaluated: pressure ulcer, postoperative sepsis, perioperative pulmonary embolus/deep vein thrombosis, and death rate among surgical inpatients with serious treatable complications ('failure to rescue') in hospitals classified into high, medium, and low Black-serving hospitals according to the percent patients of Black race in the MEDPAR data. Mean outcome differences across Black-serving hospital categories were assessed through analyses of variance and regression models, which controlled for hospital Case Mix Index.

Results: The 3,101 hospitals were predominantly urban non-teaching hospitals in metropolitan areas. Although 12% of hospitals had Magnet designation, Black-serving hospitals were disproportionately Magnet (14%). The outcome rates were 0.59 for pressure ulcers, 3.38 for perioperative pulmonary embolus/deep vein thrombosis, 143.58 for failure to rescue, and 4.12 for sepsis. Rates were significantly higher for pressure ulcers, perioperative pulmonary embolus/deep vein thrombosis, and sepsis in high Black-serving hospitals. The mean failure to rescue rate was similar across low-to-high Black-serving hospitals and did not show significant differences. These results were unchanged in models adjusting for CMI.

Discussion: The evidence suggests that several nursing-sensitive indicators are worse in high Black-serving hospitals. Research linking nursing-sensitive indicators to nursing resources such as staffing is needed to explicate the mechanism underlying these findings. Poorer nursing-sensitive indicators in combination with poorer nurse staffing in high Black-serving hospitals presents a priority for policy and management intervention.