Disparities in Perinatal Quality Outcomes for Very Low Birth Weight Infants in Neonatal Intensive Care
Disparities in Perinatal Quality Outcomes for Very Low Birth Weight Infants in Neonatal Intensive Care
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DOI：
10.1111/1475-6773.12225
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发表时间：
2015-04-01
影响因子：
3.4
通讯作者：
Rogowski, Jeannette A.
中科院分区：
文献类型：
--
作者：
Lake, Eileen T.;Staiger, Douglas;Rogowski, Jeannette A.
ObjectiveTo determine if hospital level disparities in very low birth weight（VLBW）infant outcomes are explained by poor hospital nursing characteristics.Data SourcesNurse survey and VLBW infant registry data.Study DesignRetrospective study of 8，252 VLBW infants in 98 Vermont Oxford Network hospital neonatal intensive care units（NICU）nationally.根据新生儿重症监护病房中黑人婴儿的比例，将新生儿重症监护病房分为三类。两个护士敏感的围产期质量标准进行了研究：医院感染和母乳。Data CollectionPrimary nurse survey（N= 5，773，77%的应答率）。Principal FindingsVLBW婴儿出生在高黑浓度医院有较高的感染率和出院时没有母乳比VLBW婴儿出生在低黑浓度医院。护士人手不足是更高的，实践环境更糟，在高黑相比，低黑医院。NICU护理特征占医院层面健康差异的三分之一到二分之一。结论在两个护理敏感的围产期质量标准中，较差的护理特征导致了极低出生体重婴儿结局的差异。护理的改进有可能提高在这个国家的黑人医院出生的十分之七的黑人极低出生体重婴儿的护理质量。
ObjectiveTo determine if hospital-level disparities in very low birth weight (VLBW) infant outcomes are explained by poorer hospital nursing characteristics.Data SourcesNurse survey and VLBW infant registry data.Study DesignRetrospective study of 8,252 VLBW infants in 98 Vermont Oxford Network hospital neonatal intensive care units (NICUs) nationally. NICUs were classified into three groups based on their percent of infants of black race. Two nurse-sensitive perinatal quality standards were studied: nosocomial infection and breast milk.Data CollectionPrimary nurse survey (N=5,773, 77 percent response rate).Principal FindingsVLBW infants born in high-black concentration hospitals had higher rates of infection and discharge without breast milk than VLBW infants born in low-black concentration hospitals. Nurse understaffing was higher and practice environments were worse in high-black as compared to low-black hospitals. NICU nursing features accounted for one-third to one-half of the hospital-level health disparities.ConclusionsPoorer nursing characteristics contribute to disparities in VLBW infant outcomes in two nurse-sensitive perinatal quality standards. Improvements in nursing have potential to improve the quality of care for seven out of ten black VLBW infants who are born in high-black hospitals in this country.