Hospital Performance, Nursing Resources, and Health Inequities During the COVID-19 Pandemic.

IF 2.2 4区 医学 Q1 NURSING
Ann Kutney-Lee, Daniela Golinelli, Shelli L Feder, Kelvin Eyram Amenyedor, Karen B Lasater, Matthew D McHugh, J Margo Brooks Carthon
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引用次数: 0

Abstract

Background: Few researchers have examined the organizational features of high-performing and low-performing hospitals for COVID-19 mortality during the pandemic, and how differences in hospital performance contributed to mortality disparities among socially vulnerable patients hospitalized with COVID-19.

Objectives: Our objectives were to: (a) identify high- and low-performing hospitals on COVID-19 inpatient mortality and describe their distinguishing organizational characteristics, including nursing resources, and (b) assess whether patients admitted to high-performing hospitals differed by social vulnerability level.

Methods: This analysis used linked nurse survey, hospital, and claims data for 73,792 hospitalized older adults diagnosed with COVID-19 across 96 New York and Illinois hospitals between January 1, 2020, and December 31, 2020. A robust benchmarking approach was used to identify high- and low-performing hospitals on 30-day inpatient mortality. We computed the cumulative proportion of admissions for patients in the highest and lowest Social Vulnerability index quartiles to the hospitals ranked by performance.

Results: The average mortality rate in the high-performing hospitals was 16.2% compared to 31.5% in the low-performing hospitals. Compared to low-performing hospitals, high-performing hospitals had more favorable nurse work environments and lower patient-to-nurse ratios. About half the patients in the lowest social vulnerability quartile (least vulnerable) were admitted to hospitals in the top-performing tertile of hospitals compared to 38% of patients in the highest social vulnerability quartile (most vulnerable).

Discussion: Nursing resources were a central feature of a high-performing hospital for COVID-19 mortality during the early stages of the pandemic. Patients diagnosed with COVID-19 who were admitted from the most socially vulnerable communities were less likely to be admitted to high-performing hospitals. Increasing nursing resources-particularly in hospitals that serve socially vulnerable communities-could be a key strategy for preparing for future public health emergencies and addressing health disparities.

COVID-19 大流行期间的医院绩效、护理资源和健康不平等。
背景:很少有研究者研究大流行期间高绩效医院和低绩效医院对COVID-19死亡率的组织特征,以及医院绩效差异如何导致社会弱势群体COVID-19住院患者的死亡率差异。目标:我们的目标是:(a)确定在COVID-19住院患者死亡率方面表现优异和表现不佳的医院,并描述其显著的组织特征,包括护理资源;(b)评估在表现优异的医院就诊的患者是否因社会脆弱性水平而异。方法:该分析使用了2020年1月1日至2020年12月31日期间纽约和伊利诺伊州96家医院73792名诊断为COVID-19的住院老年人的相关护士调查、医院和索赔数据。采用了一种强有力的基准方法来确定30天住院病人死亡率的高绩效和低绩效医院。我们计算了最高和最低社会脆弱性指数四分位数的患者入院的累积比例,以医院的表现排名。结果:高绩效医院的平均死亡率为16.2%,低绩效医院的平均死亡率为31.5%。与低绩效医院相比,高绩效医院有更有利的护士工作环境和更低的病人与护士比率。在社会脆弱性最低的四分位数(最不脆弱)中,约有一半的患者住进了表现最好的四分位数医院,而在社会脆弱性最高的四分位数(最脆弱)中,这一比例为38%。讨论:在大流行的早期阶段,护理资源是高绩效医院应对COVID-19死亡率的核心特征。来自社会最脆弱社区的COVID-19确诊患者入住高绩效医院的可能性较小。增加护理资源,特别是在为社会弱势社区服务的医院,可能是为未来突发公共卫生事件做好准备和解决卫生差距的关键战略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Nursing Research
Nursing Research 医学-护理
CiteScore
3.60
自引率
4.00%
发文量
102
审稿时长
6-12 weeks
期刊介绍: Nursing Research is a peer-reviewed journal celebrating over 60 years as the most sought-after nursing resource; it offers more depth, more detail, and more of what today''s nurses demand. Nursing Research covers key issues, including health promotion, human responses to illness, acute care nursing research, symptom management, cost-effectiveness, vulnerable populations, health services, and community-based nursing studies. Each issue highlights the latest research techniques, quantitative and qualitative studies, and new state-of-the-art methodological strategies, including information not yet found in textbooks. Expert commentaries and briefs are also included. In addition to 6 issues per year, Nursing Research from time to time publishes supplemental content not found anywhere else.
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