Identifying and Mitigating Health Disparities Following a Neonatal Intensive Care Unit (NICU) Design Change from Open Bay to Single Family Rooms

新生儿重症监护病房 (NICU) 设计从开放式病房改为单户家庭病房后，确定并减少健康差异

• 批准号: 10412626
• 负责人: Stephanie Teixeira-Poit
• 金额: $ 14.22万
• 依托单位: NORTH CAROLINA AGRI & TECH ST UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10412626
• 关键词: African American student; Anecdotes; Area; Attention; Black race; Caring; Child Health; Communities; Cone; Data; Data Analyses; Data Collection; Development; Disadvantaged; Economics; Ensure; Environment; Ethnic Origin; Evaluation; Family; Frequencies; Health; Health system; Historically Black Colleges and Universities; Inequality; Interview; Latinx; Lead; Learning; Lighting; Literature; Low income; Maternal and Child Health; Medical; Methods; Mothers; Needs Assessment; Neonatal Intensive Care Units; Newborn Infant; Noise; Nurses; Outcome; Parents; Patient Care Team; Patients; Perception; Policies; Premature Birth; Procedures; Process; Quality of Care; Race; Recommendation; Reduce health disparities; Research; Review Literature; Safety; Schools; Sensory Deprivation; Socioeconomic Status; Structure; Students; Surveys; Time; Transportation; Woman; Workload; care delivery; design; disparity reduction; experience; health care delivery; health disparity; improved; job market; neonate; patient subsets; racial disparity; skills; social health determinants; trend

Project Abstract With over 400,000 preterm births in the US annually, neonatal intensive care units (NICUs) are critical to providing high quality care and ensuring optimal health outcomes for neonates. Neonatal intensive care units (NICUs) began as open-bays (large rooms, variable size, and multiple newborns admitted), but the latest NICU design and a growing trend is single family rooms that typically have only one baby admitted per room and accommodate at least one parent rooming-in. The scholarly literature provides mixed- evidence on the impact of NICU design changes on patient health outcomes and patient experience of care. Also, a recent community needs assessment called to reduce disparities in maternal and child health by race and ethnicity. These lead us to conduct a mixed-methods process and outcome evaluation examining the impact of a NICU transition from open bay to single family rooms that occurred at Cone Health in Greensboro, NC. A theoretical benefit of single family room designs is increased parent-neonate bonding time, yet this assumes that parents routinely room-in with neonates. Black and low income parents may experience economic and transportation hardships that constrain their opportunity to room-in at the frequency of white and economically privileged parents. Thus, we hypothesize that single family rooms disproportionately benefit neonates from economically privileged families (predominantly white) compared to neonates from families with low incomes (predominantly Black and LatinX in our community). We will conduct a mixed-methods study that triangulates patient health outcome data, patient experience surveys, and in-depth interviews with NICU staff to explore whether different patient sub-populations unequally benefited from or were unintentionally harmed by a NICU design change from open-bay to single family rooms. A secondary data analysis will help us determine whether patient health outcomes and patient experience of care changed before vs. after the NICU transition from open-bay to single family rooms. We will examine health disparities across patient sub-populations, with special attention to race/ethnicity and socioeconomic status. We will then collect and analyze qualitative data to provide rich detail on processes that reproduce health disparities; we will explore barriers and facilitators to implementing strategies to mitigate unintended consequences, improve care delivery, improve health outcomes, and reduce health disparities among patient sub- populations. Using a community engaged approach with a Stakeholder Advisory Board, we will develop a conceptual framework on the impact of NICU design changes and disseminate lessons learned and actionable recommendations to drive systemic changes to policies and procedures at health systems to improve patient quality of care, improve health outcomes, and reduce health disparities.

项目摘要 美国每年有超过 400,000 例早产，新生儿重症监护病房 (NICU) 对于预防早产至关重要 提供高质量的护理并确保新生儿获得最佳的健康结果。新生儿重症监护 新生儿重症监护病房 (NICU) 最初是开放式的（大房间、可变大小、可容纳多名新生儿），但 最新的新生儿重症监护室 (NICU) 设计和日益增长的趋势是单户家庭病房通常只容纳一名婴儿 每个房间至少可容纳一名家长同住。学术文献提供了混合的 NICU 设计变更对患者健康结果和患者体验影响的证据 关心。此外，最近的一项社区需求评估呼吁减少孕产妇和儿童之间的差距 健康状况按种族和民族划分。这些导致我们进行混合方法的过程和结果 评估检查新生儿重症监护病房从开放式病房过渡到单户病房的影响， 发生在北卡罗来纳州格林斯博罗的 Cone Health。单一家庭房间设计的理论上的好处是 增加了父母与新生儿的亲密时间，但这假设父母经常与新生儿同房。 黑人和低收入父母可能会遇到经济和交通困难，从而限制 他们有机会像白人和经济上享有特权的父母一样同室同住。因此，我们 假设单户家庭房对经济上享有特权的新生儿不成比例地有利 家庭（主要是白人）与低收入家庭（主要是白人）的新生儿相比 我们社区中的黑人和拉丁裔）。我们将进行一项混合方法研究，对患者进行三角测量 健康结果数据、患者体验调查以及对 NICU 工作人员的深入访谈以探索 不同的患者亚群是否从治疗中受益不均或无意中受到伤害 新生儿重症监护病房 (NICU) 设计从开放式房间改为单户家庭病房。二次数据分析将帮助我们 确定患者的健康结果和患者的护理体验在治疗前后是否发生变化 NICU 从开放式病房过渡到单户病房。我们将检查患者之间的健康差异 亚人群，特别关注种族/族裔和社会经济地位。然后我们将收集 分析定性数据，提供再现健康差异过程的丰富细节；我们将 探索实施战略以减轻意外后果的障碍和促进因素， 改善护理服务、改善健康结果并减少患者亚群之间的健康差距 人口。通过利益相关者咨询委员会的社区参与方法，我们将开发 关于 NICU 设计变更影响的概念框架并传播经验教训 推动卫生系统政策和程序进行系统性变革的可行建议 提高患者护理质量、改善健康结果并减少健康差距。