Nursing Impact on Care Outcomes for Chronically Ill and Minority Patients This revised competing continuation (R01NR04513) extends a highly successful program of research that has influenced changes in practice and policy, and stimulated global interest in nursing outcomes research. We extend our work on the significant association between preventable hospitals deaths and the organizational context of nursing care into new domains of theoretical relevance and substantive interest, new patient populations, and new outcomes. We have documented in our current work significant increases in chronic health conditions among people seeking hospital care for acute medical illnesses such as acute myocardial infarction, stroke, gastrointestinal bleeding, and acute congestive heart failure, and for general surgery, reflecting changes in population health. We will determine whether nursing factors are particularly important for preventing adverse outcomes during hospitalization for these at-risk patients. Our greatest interest is in three conditions that are increasing significantly among hospitalized patients and have important implications for nursing care: obesity, diabetes, and chronic pulmonary disease. We look not only at the outcomes for individual patients with these underlying chronic conditions. We also examine whether the outcomes for patients without chronic conditions are poorer in hospitals with higher concentrations of patients with these particular chronic conditions. All else being equal, we expect that non-chronic patients in hospitals with high concentrations of chronic patients may not benefit as much from better nurse staffing and care environments as similar patients in hospitals with lower concentrations of chronic patients because nurses in the former hospitals devote relatively more attention to those at risk of poor outcomes but are not likely to be better staffed. Similarly, we turn our attention to racial and ethnic disparities in hospital outcomes to test whether poorer outcomes for minorities are explained by a combination of multiple underlying chronic health conditions and the concentration of minorities in hospitals with poor nurse staffing and education and less satisfactory care environments. Surprisingly the large literature on health disparities rarely considers how nursing might be a factor that explains poor outcomes, which is a necessary step to understanding whether improving nurse staffing and care environments is likely to contribute to reducing disparities in hospital outcomes. The findings have implications for nurse staffing standards and hospital payment, particularly for minority-serving hospitals.
Changes in population health, including sharp increases in chronic conditions, contribute to the complexity of hospital care and increase the risk for poor outcomes. Disparities in hospital outcomes by race and ethnicity persist. This study examines whether improving nursing resources in hospitals would be a potentially effective strategy to improve outcomes in these overlapping populations.
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