Nursing research · 2025
Hospital Performance, Nursing Resources, and Health Inequities During the COVID-19 Pandemic.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Kutney-Lee Ann, Golinelli Daniela, Feder Shelli L, Amenyedor Kelvin Eyram, Lasater Karen B, McHugh Matthew D, Carthon J Margo Brooks
Аннотация
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 (a) to identify high- and low-performing hospitals on COVID-19 inpatient mortality and describe their distinguishing organizational characteristics, including nursing resources, and (b) to 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.
OBJECTIVES: Our objectives were (a) to identify high- and low-performing hospitals on COVID-19 inpatient mortality and describe their distinguishing organizational characteristics, including nursing resources, and (b) to 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.