Hospital Quality of Care and Racial and Ethnic Disparities in Unexpected Newborn Complications.
Hospital Quality of Care and Racial and Ethnic Disparities in Unexpected Newborn Complications.
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医院护理质量和意外新生儿并发症的种族和民族差异。
DOI：
10.1542/peds.2020-024091
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发表时间：
2021-09
期刊：
影响因子：
8
通讯作者：
Howell, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Glazer, Kimberly B.;Zeitlin, Jennifer;Egorova, Natalia N.;Janevic, Teresa;Balbierz, Amy;Hebert, Paul L.;Howell, Elizabeth A.
调查非预期足月新生儿发病率的种族和民族差异以及医院质量对差异的影响。我们使用了2010-2014年纽约市40家医院的出生证明和出院摘要数据，对483834例低风险（足月、单胎、出生体重≥2500 g、无既往胎儿疾病）新生儿进行了回顾性队列研究。我们根据联合委员会的新生儿意外并发症指标对发病率进行分类，并使用多变量logistic回归来比较种族和民族之间的发病风险。我们使用混合效应逻辑回归为每家医院生成了风险标准化并发症发生率，以评估质量，对医院进行了排名，并评估了各机构出生的种族和民族分布差异。意外并发症发生率为48.0/1000。根据患者特征调整后，黑人和西班牙裔婴儿的发病风险高于白色婴儿（比值比：1.5 [95%置信区间1.3-1.9];比值比：1.2 [95%置信区间1.1-1.4]）。在40家医院中，风险标准化并发症的范围为每1000例分娩25.3至162.8例。三分之一的黑人和西班牙裔妇女在发病率最高的三分之一的医院分娩，而白色和亚裔美国妇女为10%（P < .001）。与白色或亚裔美国妇女相比，黑人和西班牙裔妇女更有可能在并发症发生率高的医院分娩。研究结果表明，医院质量有助于预防新生儿健康的差异之间的低风险，足月分娩。针对常规产科和新生儿护理的质量改进对于围产期结果的公平至关重要。
To investigate racial and ethnic differences in unexpected, term newborn morbidity and the influence of hospital quality on disparities. We used 2010–2014 birth certificate and discharge abstract data from 40 New York City hospitals in a retrospective cohort study of 483 834 low-risk (term, singleton, birth weight ≥2500 g, without preexisting fetal conditions) neonates. We classified morbidity according to The Joint Commission’s unexpected newborn complications metric and used multivariable logistic regression to compare morbidity risk among racial and ethnic groups. We generated risk-standardized complication rates for each hospital using mixed-effects logistic regression to evaluate quality, ranked hospitals on this measure, and assessed differences in the racial and ethnic distribution of births across facilities. The unexpected complications rate was 48.0 per1000 births. Adjusted for patient characteristics, morbidity risk was higher among Black and Hispanic infants compared with white infants (odds ratio: 1.5 [95% confidence interval 1.3–1.9]; odds ratio: 1.2 [95% confidence interval 1.1–1.4], respectively). Among the 40 hospitals, risk-standardized complications ranged from25.3 to 162.8 per 1000 births. One-third of Black and Hispanic women gave birth in hospitals ranking in the highest-morbidity tertile, compared with10% of white and Asian American women (P < .001). Black and Hispanic women were more likely to deliver in hospitals with high complication rates than were white or Asian American women. Findings implicate hospital quality in contributing to preventable newborn health disparities among low-risk, term births. Quality improvement targeting routine obstetric and neonatal care is critical for equity in perinatal outcomes.
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影响因子：
120.7
作者：
Howell, Elizabeth A.;Zeitlin, Jennifer;Hebert, Paul L.;Balbierz, Amy;Egorova, Natalia
通讯作者：
Egorova, Natalia
影响因子：
3.4
作者：
Hebert, Paul L.;Howell, Elizabeth A.;Liu, Chuan-Fen
通讯作者：
Liu, Chuan-Fen
影响因子：
9.8
作者：
Creanga, Andreea A.;Bateman, Brian T.;Callaghan, William M.
通讯作者：
Callaghan, William M.
影响因子：
12.7
作者：
KOTELCHUCK, M
通讯作者：
KOTELCHUCK, M
影响因子：
2.8
作者：
Bryant, Allison S.;Washington, Sierra;Caughey, Aaron B.
通讯作者：
Caughey, Aaron B.