Worse Nursing-Sensitive Indicators in Black-serving Hospitals

Background In hospitals that serve disproportionately patients of black race, here termed Black-serving hospitals, nurse staffing is worse, mortality rates are higher, and nursing-sensitive indicators may be worse than in other hospitals, but this evidence has not been compiled. Objective The study objective was to examine whether nursing-sensitive indicators, which measure changes in patient health status directly affected by nursing care, differ in hospitals where Black patients predominantly access their care, as compared to other hospitals. Methods To fulfill the objective, a cross-sectional design using publicly available 2019 to 2022 Hospital Compare and 2019 Medicare Provider Analysis and Review (MEDPAR) and Case Mix Index file databases was used. Four nursing-sensitive indicators were evaluated: pressure ulcer, postoperative sepsis, perioperative pulmonary embolus/deep vein thrombosis, and death rate among surgical inpatients with serious treatable complications ('failure to rescue') in hospitals classified into high, medium, and low Black-serving hospitals according to the percent patients of Black race in the MEDPAR data. Mean outcome differences across Black-serving hospital categories were assessed through analyses of variance and regression models, which controlled for hospital Case Mix Index. Results The 3,101 hospitals were predominantly urban non-teaching hospitals in metropolitan areas. Although 12% of hospitals had Magnet designation, Black-serving hospitals were disproportionately Magnet (14%). The outcome rates were 0.59 for pressure ulcers, 3.38 for perioperative pulmonary embolus/deep vein thrombosis, 143.58 for failure to rescue, and 4.12 for sepsis. Rates were significantly higher for pressure ulcers, perioperative pulmonary embolus/deep vein thrombosis, and sepsis in high Black-serving hospitals. The mean failure to rescue rate was similar across low-to-high Black-serving hospitals and did not show significant differences. These results were unchanged in models adjusting for CMI. Discussion The evidence suggests that several nursing-sensitive indicators are worse in high Black-serving hospitals. Research linking nursing-sensitive indicators to nursing resources such as staffing is needed to explicate the mechanism underlying these findings. Poorer nursing-sensitive indicators in combination with poorer nurse staffing in high Black-serving hospitals presents a priority for policy and management intervention.