Differences in Labor Progress, Care Received During Labor, and Provider-Patient Communication and Decision-Making Quality among Low-Risk Black vs. White Nulliparous Women with Spontaneous Labor Onset

自然分娩的低风险黑人与白人初产妇女在分娩进展、分娩期间接受的护理以及医患沟通和决策质量方面的差异

• 批准号: 10218513
• 负责人: JEREMY L NEAL
• 金额: $ 25.55万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-12 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10218513
• 关键词: Academic Medical Centers; Accounting; Adopted; American College of Obstetricians and Gynecologists; Birth; Birth Rate; Caring; Categories; Cervical; Cesarean section; Characteristics; Clinical; Cohort Studies; Communication; Data; Data Collection; Data Set; Decision Making; Diagnosis; Diagnostic; Discipline of obstetrics; Dystocia; Elements; Fetus; Guidelines; Health Care Costs; Hospitalization; Hospitals; Institution; Intervention; Labor Dystocia; Labor Onset; Logistics; Maternal-fetal medicine; Measures; Medical; Methods; Midwife; Modeling; Nulliparity; Outcome; Patients; Perception; Perinatal mortality demographics; Polynomial Models; Postpartum Period; Pregnancy; Provider; Public Health; Publishing; Race; Research; Risk; Safety; Sampling; Societies; Testing; United States; Woman; base; black patient; black women; clinical care; disparity elimination; experience; health care settings; health equity; implicit bias; improved; intrapartum; patient-clinician communication; perinatal morbidity; perinatal outcomes; population health; prevent; provider adherence; racial difference; racial disparity; recruit; satisfaction; shared decision making; treatment disparity

PROJECT SUMMARY The disparity in primary cesarean birth rates between low-risk Black and White nulliparous women with a term, single, vertex fetus (NTSV) in the United States is greater than ever before. This is concerning because NTSV women enter hospitals with similar baseline risks for cesarean birth. Safely lowering the cesarean rate, eliminating disparities, and achieving health equity for all groups are ongoing national priorities. It is unknown why disparities in cesarean rates exist between races but differences in labor progress, provider-level practice, or provider-patient communication and decision making quality may be contributory. Dystocia (slow, abnormal progression of labor) is the indication for half of cesareans among NTSV women, yet this diagnostic category remains poorly defined and provides a key opportunity to safely reduce primary cesarean births. There is contradictory evidence regarding whether Black and White NTSV women have similar dilation rates during labor. If racial differences in labor progress exist, this would have major implications for diagnosing dystocia and clinical determinations for performing cesarean births. Furthermore, it is unclear if provider application of American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine guidelines for safely preventing primary cesareans are applied differently based on maternal race. Finally, disparate provider-patient communications and decision making as well as provider implicit bias may contribute to higher cesarean rates for Black NTSV women although this has not yet been studied. The purpose of this study is to compare Black and White NTSV women with spontaneous labor onset on (1) labor progress, (2) care received during labor, and (3) indicators of provider-patient communication and decision making quality. Retrospective and cross- sectional data will be collected for this study. Labor and birth data will be retrospectively collected from Black and White NTSV women who birthed at Vanderbilt University Medical Center following a pregnancy with spontaneous labor onset since 2015 (n ≈ 7,150). For cross-sectional data collection, Black (n = 140) and White (n = 140) women who birthed following a NTSV pregnancy with spontaneous labor onset will be recruited and complete measures during their postpartum hospitalizations. Regression methods (polynomial, multiple logistic, and linear) and will primarily be used to test hypotheses. Labor attendant type, maternal and pregnancy characteristics, and common labor interventions will be model covariates. If study hypotheses are supported, specific guidelines for assessing progress and diagnosing dystocia based on race may be necessary for closing the cesarean rate disparity. Moreover, study findings will be the first to describe Black vs. White provider-patient communication and decision making quality in an obstetrical setting at a high-volume, academic medical center. Findings from this R21 study will inform next research steps necessary for improving clinical care and closing the Black vs. White disparity in cesarean births.

项目总结 低风险黑人和白人足月未产妇初次剖宫产率的差异， 在美国，单顶胎儿(NTSV)比以往任何时候都要大。这是令人担忧的，因为NTSV 妇女进入医院时，剖腹产的基线风险类似。安全地降低剖腹产率， 消除不平等和实现所有群体的健康公平是目前的国家优先事项。这是未知的 为什么剖宫产率在种族之间存在差异，但在劳动力进步、提供者级别的做法、 或者，提供者与患者之间的沟通和决策质量也可能起到一定作用。难产(缓慢、异常 产程进展)是NTSV妇女中一半剖宫产的指征，但这一诊断类别 仍然没有明确的定义，为安全减少初次剖腹产提供了一个关键机会。的确有 关于黑人和白人NTSV妇女在分娩期间是否有相似的扩张率的相互矛盾的证据。 如果在分娩过程中存在种族差异，这将对诊断难产和临床具有重大意义。 剖宫产的决定。此外，目前还不清楚美国的供应商应用程序 妇产科医生学院和母婴医学学会的安全指南 预防初次剖腹产根据产妇种族的不同而有所不同。最后，不同的提供者-患者 沟通和决策以及提供者的隐性偏见可能会导致较高的剖宫产率 对于黑人NTSV妇女，尽管这还没有被研究过。这项研究的目的是比较布莱克 和自然分娩的白人NTSV妇女在(1)分娩进展，(2)在分娩期间接受护理， (3)医患沟通和决策质量指标。回顾和交叉- 本研究将收集横断面数据。劳工和出生数据将从Black回溯收集 和在范德比尔特大学医学中心出生的白人NTSV妇女 自2015年起自然分娩(n≈7,150)。对于横断面数据收集，黑色(n=140)和白色 (n=140)在NTSV妊娠后自然分娩的妇女将被招募并 在产后住院期间完成各项措施。回归方法(多项式、多元Logistic、 和线性)，并且将主要用于检验假设。助产士类型，产妇和怀孕 特征，以及常见的劳动干预将成为模型协变量。如果研究假设得到支持， 根据种族评估进展和诊断难产的具体指南可能是结束时所必需的 剖腹产率的差距。此外，研究结果将首次描述黑人和白人提供者-患者 在高容量的学术医疗中心产科环境中的沟通和决策质量。 这项R21研究的结果将为下一步改善临床护理和结束研究提供必要的信息 剖腹产中的黑人和白人的差异。