Distinguishing High-Performing From Low-Performing Hospitals for Severe Maternal Morbidity: A Focus on Quality and Equity.
Distinguishing High-Performing From Low-Performing Hospitals for Severe Maternal Morbidity: A Focus on Quality and Equity.
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DOI：
10.1097/aog.0000000000004806
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发表时间：
2022-06-01
影响因子：
7.2
通讯作者：
Zeitlin, Jennifer
中科院分区：
文献类型：
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作者：
Howell, Elizabeth A.;Sofaer, Shoshanna;Balbierz, Amy;Kheyfets, Anna;Glazer, Kimberly B.;Zeitlin, Jennifer
调查哪些组织因素、政策和实践将医院的严重孕产妇发病率区分为高风险调整率和低风险调整率。使用积极的偏差方法，这项定性研究包括50个半结构化的采访与医疗保健专业人员（妇产科椅子，劳动和交付医疗主任，护士经理，一线护士，医生或护士负责质量和安全，首席医疗官）在四个低性能和四个高性能医院在纽约市。医院绩效是基于先前研究中的风险调整后的发病率指标。探讨的主要主题是结构特征（如人员配备，资格认证），组织特征（如文化，领导，沟通，数据的使用），劳动和交付的做法（如使用标准化的循证实践，团队合作），以及种族和民族的差异，严重孕产妇发病率。所有访谈都进行了录音，专业转录，并使用NVivo软件编码。研究者对分组不知情，进行了定性内容分析。研究人员撰写了分析备忘录，以确定访谈中出现的关键主题和模式，突出说明性的引用，并在两个具有不同（但未透露）绩效水平的医院集群之间进行定性比较。六个主题区分高绩效医院和低绩效医院。高绩效医院更有可能：1）参与日常质量活动并致力于质量改进的高级领导层，2）对标准和标准化护理的强烈关注，3）强大的护士-医生沟通和团队合作，4）足够的医生和护士人员配置和监督，5）与护士和其他一线临床医生共享绩效数据，6）明确认识到种族和民族差异的存在，以及医院中的种族主义和偏见可能导致差别待遇。组织因素，政策和实践在多个层面区分高绩效医院和低绩效医院的严重孕产妇发病率。调查结果表明，有针对性的质量倡议，以改善孕产妇健康和减少产科差异所产生的低性能医院交付的潜力。组织因素，政策和实践在多个层面区分高绩效医院和低绩效医院的严重孕产妇发病率。
To investigate which organizational factors, policies, and practices distinguish hospitals with high compared with low risk-adjusted rates of severe maternal morbidity. Using a positive deviance approach, this qualitative study included 50 semi-structured interviews with healthcare professionals (obstetrics and gynecology chairs, labor and delivery medical directors, nurse managers, frontline nurses, physicians or nurses responsible for quality and safety, chief medical officers) in four low-performing and four high-performing hospitals in New York City. Hospital performance was based on risk-adjusted morbidity metrics from previous research. Major topics explored were structural characteristics (e.g. staffing, credentialing), organization characteristics (e.g. culture, leadership, communication, use of data), labor and delivery practices (e.g. use of standardized evidence-based practices, teamwork), and racial and ethnic disparities in severe maternal morbidity. All interviews were audiotaped, professionally transcribed, and coded using NVivo software. Researchers blinded to group assignment conducted qualitative content analysis. Researchers wrote analytic memos to identify key themes and patterns emerging from the interviews, highlight illustrative quotes, and draw qualitative comparisons between the two hospital clusters with different (but unrevealed) performance levels. Six themes distinguished high- from low-performing hospitals. High- performing hospitals were more likely to have: 1) senior leadership involved in day-to- day quality activities and dedicated to quality improvement, 2) a strong focus on standards and standardized care, 3) strong nurse–physician communication and teamwork, 4) adequate physician and nurse staffing and supervision, 5) sharing of performance data with nurses and other frontline clinicians, and 6) explicit awareness that racial and ethnic disparities exist and that racism and bias in the hospital can lead to differential treatment. Organizational factors, policies, and practices at multiple levels distinguish high from low-performing hospitals for severe maternal morbidity. Findings illustrate the potential for targeted quality initiatives to improve maternal health and reduce obstetric disparities arising from delivery in low-performing hospitals. Organizational factors, policies, and practices at multiple levels distinguish high from low-performing hospitals for severe maternal morbidity.