Brooks-Carthon J Margo, Lasater Karen B, Rearden Jessica, Holland Sara, Sloane Douglas M
Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA.
Med Care. 2016 May;54(5):457-65. doi: 10.1097/MLR.0000000000000519.
Recent studies suggest that nurses may be unable to complete all aspects of necessary care due to a lack of time. Research is needed to determine whether unmet nursing care contributes to disparities in readmissions for vulnerable populations.
To examine differences in the relationship between nursing care left undone and acute myocardial infarction readmissions among older black patients compared with older white patients.
Cross-sectional analysis of multiple datasets, including: 2006 to 2007 administrative discharge data, a survey of registered nurses, and the American Hospital Association Annual Survey. Risk-adjusted logistic regression models were used to estimate the association between care left undone and 30-day readmission. Interactions were used to examine the moderating effect of care left undone on readmission by race.
The sample included 69,065 patients in 253 hospitals in California, New Jersey, and Pennsylvania. Older black patients were 18% more likely to experience a readmission after adjusting for patient and hospital characteristics and more likely to be in hospitals where nursing care was often left undone. Black patients were more likely to be readmitted when nurses were unable to talk/comfort patients [odds ratio (OR), 1.09; 95% confidence interval (CI), 1.01-1.19], complete documentation (OR, 1.16; 95% CI, 1.01-1.32), or administer medications in a timely manner (OR, 1.26; 95% CI, 1.09-1.46).
Unmet nursing care is associated with readmissions for older black patients following acute myocardial infarction. Investment in nursing resources to improve the delivery of nursing care may decrease disparities in readmission.
近期研究表明，由于时间不足，护士可能无法完成必要护理的所有方面。需要开展研究以确定未得到满足的护理是否会导致弱势群体再入院率的差异。
比较老年黑人患者与老年白人患者在未完成的护理与急性心肌梗死再入院之间关系上的差异。
对多个数据集进行横断面分析，包括：2006年至2007年行政出院数据、注册护士调查以及美国医院协会年度调查。采用风险调整逻辑回归模型来估计未完成护理与30天再入院之间的关联。通过交互作用来检验未完成护理对不同种族再入院的调节作用。
样本包括加利福尼亚州、新泽西州和宾夕法尼亚州253家医院的69,065名患者。在对患者和医院特征进行调整后，老年黑人患者再入院的可能性高出18%，且更有可能在经常存在未完成护理情况的医院。当护士无法与患者交谈/安慰患者时，黑人患者更有可能再入院[比值比（OR），1.09；95%置信区间（CI），1.01 - 1.19]，无法完成记录时（OR，1.16；95% CI，1.01 - 1.32），或无法及时给药时（OR，1.26；95% CI，1.09 - 1.46）。
未得到满足的护理与老年黑人患者急性心肌梗死后的再入院有关。投入护理资源以改善护理服务的提供可能会减少再入院方面的差异。
