Ann Kutney-Lee, Daniela Golinelli, Shelli L Feder, Kelvin Eyram Amenyedor, Karen B Lasater, Matthew D McHugh, J Margo Brooks Carthon
{"title":"COVID-19 大流行期间的医院绩效、护理资源和健康不平等。","authors":"Ann Kutney-Lee, Daniela Golinelli, Shelli L Feder, Kelvin Eyram Amenyedor, Karen B Lasater, Matthew D McHugh, J Margo Brooks Carthon","doi":"10.1097/NNR.0000000000000821","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Discussion: </strong>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.</p>","PeriodicalId":49723,"journal":{"name":"Nursing Research","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Hospital Performance, Nursing Resources, and Health Inequities During the COVID-19 Pandemic.\",\"authors\":\"Ann Kutney-Lee, Daniela Golinelli, Shelli L Feder, Kelvin Eyram Amenyedor, Karen B Lasater, Matthew D McHugh, J Margo Brooks Carthon\",\"doi\":\"10.1097/NNR.0000000000000821\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Discussion: </strong>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.</p>\",\"PeriodicalId\":49723,\"journal\":{\"name\":\"Nursing Research\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-03-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Nursing Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/NNR.0000000000000821\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nursing Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/NNR.0000000000000821","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
Hospital Performance, Nursing Resources, and Health Inequities During the COVID-19 Pandemic.
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.
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.