Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.
BMJ Open. 2024 Nov 4;14(11):e082421. doi: 10.1136/bmjopen-2023-082421.
To describe variation in hospital organisational factors across high- and low-performing hospitals with regard to spontaneous vaginal birth (SVB) for Black women.
Cross-sectional descriptive.
We conducted a cross-sectional study using three datasets in four states from 2016, including the American Hospital Association Annual Survey, administrative discharge abstracts and a survey in which nurses served as informants about the organisational factors in their hospitals. Hospitals were categorised based on whether they achieved (1) the SVB rate target for Black women at low risk for caesarean birth, (2) the SVB rate target for Black women at low risk for caesarean birth and equivalent SVB rates between Black and White women at low risk for caesarean birth, or (3) neither of these metrics. The first two categories above were considered 'high performing' and the third 'low performing'. Analysis of variances were used to compare organisational factors between hospital categories.
There were 257 hospitals in the sample.
Outcomes were meeting the SVB rate targets for Black women at low risk for caesarean birth and SVB rate equivalence between Blacks and White patients.
High-performing hospitals had better nurse work environments (2.84 vs 2.695, p =0.04), including better nurse-physician relationships (2.77 vs 2.695, p =0.02). There were statistically significantly more advanced practice nurses (APNs) on average in maternity units in high-performing hospitals compared with low performing (3.51 to 2.76; p=0.003).
Better rated nurse work environments and the presence of APNs were distinguishing characteristics of high-performing hospitals. These organisational factors may be system-level targets for hospital-level interventions to improve SVB rates and equity therein.
描述高绩效和低绩效医院在黑人女性自然分娩（SVB）方面的医院组织因素差异。
横断面描述性研究。
我们使用来自四个州的 2016 年三个数据集进行了一项横断面研究，包括美国医院协会年度调查、行政出院摘要以及一项调查，其中护士作为其所在医院组织因素的信息提供者。根据是否达到（1）低剖宫产风险黑人女性的 SVB 率目标，（2）低剖宫产风险黑人女性的 SVB 率目标和低剖宫产风险黑人与白人女性的等效 SVB 率，或（3）这两个指标均未达到，对医院进行分类。前两个类别被认为是“高绩效”，第三个类别是“低绩效”。方差分析用于比较医院类别之间的组织因素。
样本中共有 257 家医院。
结果是达到低剖宫产风险黑人女性的 SVB 率目标和黑人与白人患者之间的 SVB 率等效。
高绩效医院的护士工作环境更好（2.84 与 2.695，p =0.04），包括更好的护士-医生关系（2.77 与 2.695，p =0.02）。高绩效医院的产科病房平均有更多的高级执业护士（APN），而低绩效医院的 APN 则更少（3.51 比 2.76；p=0.003）。
更好的护士工作环境评级和 APN 的存在是高绩效医院的区别特征。这些组织因素可能是针对医院层面干预措施的系统层面目标，以提高 SVB 率和其中的公平性。
