Post by Nadica (She/Her) on Oct 18, 2024 3:47:56 GMT
COVID-19 Mortality Disparities Among Socially Vulnerable Medicare Beneficiaries Associated With the Quality of Nurse Work Environments in U.S. Hospitals - Published Sept 25, 2024
Abstract
COVID-19 mortality disparities for socially vulnerable patients, including individuals facing higher levels of poverty, housing insecurity, and limited transportation, have been linked to the quality of hospitals where they received care. Few studies have examined the specific aspects of hospitals, such as nursing care quality, that may underlie disparate outcomes. Recent studies suggest that nursing resources in the pre-pandemic period were associated with mortality during the COVID-19 public health emergency. In this study, we examined the association between social vulnerability, the nurse work environment, and inpatient mortality among Medicare beneficiaries hospitalized with COVID-19. A cross-sectional analysis was conducted of linked survey data collected from nurses working in New York and Illinois, Medicare claims, American Hospital Association Annual Survey data, and the Social Vulnerability Index (SVI). Higher mortality rates were observed among patients in the highest quartile of social vulnerability compared to the lowest (6870 [25.8%] vs 5019 [19.1%]; P < .001). Using multivariable regression modeling, a statistically significant interaction was found between the highest SVI quartile and the nurse work environment (OR, 0.86; 95% CI, 0.76-0.98; P < .05), implying that the effect of a higher quality nurse work environment on mortality was decidedly greater for patients in the highest quartile (odds ratio = 0.86 × 0.94 = 0.80) compared to patients in the lowest quartile (OR, 0.94). Post-hoc analyses demonstrated that hundreds of COVID-19 related deaths among the most socially vulnerable patients may have been avoided if all hospitals had a high-quality nurse work environment. Strengthening the quality of nurse work environments may help to reduce health disparities and should be considered in public health emergency planning, specifically in hospitals serving socially vulnerable communities.
What is already known on this topic?
Mortality disparities among socially vulnerable patients, including individuals facing higher levels of poverty, housing insecurity, and limited transportation, were well documented during the COVID-19 pandemic and were linked in part to hospital quality. Less is known about the specific aspects of hospitals, including the extent to which the pre-pandemic quality of the nurse work environment was associated with the outcomes of socially vulnerable adults hospitalized with COVID-19 during the pandemic.
What this study adds?
In this cross-sectional study of 105,560 Medicare beneficiaries with a diagnosis of COVID-19 in 238 acute care hospitals, higher nurse work environment quality was associated with a 20% reduction in the odds of mortality among patients residing in the most socially vulnerable neighborhoods. Our finding that mortality disparities narrowed when patients from the most socially vulnerable neighborhoods were cared for in hospitals with the best nurse work environments suggests the need for investments in nursing resources in hospitals serving these communities. Of note, we find that hundreds of deaths could have been avoided had the most socially vulnerable patients been admitted to hospitals characterized by high quality nurse work environments.
How this study might affect research, practice or policy?
Strengthening the quality of nurse work environments may represent a public health intervention to promote the health of socially vulnerable adults and should be incorporated into emergency response planning, specifically in hospitals serving socially vulnerable communities.
Abstract
COVID-19 mortality disparities for socially vulnerable patients, including individuals facing higher levels of poverty, housing insecurity, and limited transportation, have been linked to the quality of hospitals where they received care. Few studies have examined the specific aspects of hospitals, such as nursing care quality, that may underlie disparate outcomes. Recent studies suggest that nursing resources in the pre-pandemic period were associated with mortality during the COVID-19 public health emergency. In this study, we examined the association between social vulnerability, the nurse work environment, and inpatient mortality among Medicare beneficiaries hospitalized with COVID-19. A cross-sectional analysis was conducted of linked survey data collected from nurses working in New York and Illinois, Medicare claims, American Hospital Association Annual Survey data, and the Social Vulnerability Index (SVI). Higher mortality rates were observed among patients in the highest quartile of social vulnerability compared to the lowest (6870 [25.8%] vs 5019 [19.1%]; P < .001). Using multivariable regression modeling, a statistically significant interaction was found between the highest SVI quartile and the nurse work environment (OR, 0.86; 95% CI, 0.76-0.98; P < .05), implying that the effect of a higher quality nurse work environment on mortality was decidedly greater for patients in the highest quartile (odds ratio = 0.86 × 0.94 = 0.80) compared to patients in the lowest quartile (OR, 0.94). Post-hoc analyses demonstrated that hundreds of COVID-19 related deaths among the most socially vulnerable patients may have been avoided if all hospitals had a high-quality nurse work environment. Strengthening the quality of nurse work environments may help to reduce health disparities and should be considered in public health emergency planning, specifically in hospitals serving socially vulnerable communities.
What is already known on this topic?
Mortality disparities among socially vulnerable patients, including individuals facing higher levels of poverty, housing insecurity, and limited transportation, were well documented during the COVID-19 pandemic and were linked in part to hospital quality. Less is known about the specific aspects of hospitals, including the extent to which the pre-pandemic quality of the nurse work environment was associated with the outcomes of socially vulnerable adults hospitalized with COVID-19 during the pandemic.
What this study adds?
In this cross-sectional study of 105,560 Medicare beneficiaries with a diagnosis of COVID-19 in 238 acute care hospitals, higher nurse work environment quality was associated with a 20% reduction in the odds of mortality among patients residing in the most socially vulnerable neighborhoods. Our finding that mortality disparities narrowed when patients from the most socially vulnerable neighborhoods were cared for in hospitals with the best nurse work environments suggests the need for investments in nursing resources in hospitals serving these communities. Of note, we find that hundreds of deaths could have been avoided had the most socially vulnerable patients been admitted to hospitals characterized by high quality nurse work environments.
How this study might affect research, practice or policy?
Strengthening the quality of nurse work environments may represent a public health intervention to promote the health of socially vulnerable adults and should be incorporated into emergency response planning, specifically in hospitals serving socially vulnerable communities.