ASSESSING VARIATIONS IN MANAGEMENT OF PREMATURITY

评估早产管理的差异

• 批准号: 6479459
• 负责人: MARK R CHASSIN
• 金额: $ 17.95万
• 依托单位: MOUNT SINAI SCHOOL OF MEDICINE OF CUNY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-01 至 2002-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6479459
• 关键词: African American; Hispanic Americans; behavioral /social science research tag; body temperature regulation; caucasian American; clinical research; corticosteroids; health care policy; health care quality; health care referral /consultation; health care service evaluation; health services research tag; hormone therapy; human data; human morbidity; human subject; infant mortality; medical records; outcomes research; patient care management; premature infant human; pulmonary surfactants; racial /ethnic difference; respiratory therapy

Black infants in the U.S. are more than twice as likely to die as white infants. In upper Manhattan, infant mortality rates are four times higher for the minority communities of East and Central Harlem as compared with the predominantly white Upper East Side. This disparity in mortality rates is linked to a greater incidence of prematurity among blacks. Very low birth weight infants (<1500 grams) are 90 times more likely to die than normal birth weight infants, and very low birthweight is 3.5 times more common among blacks than it is among whites. While black infants are much more likely than whites to be born premature, several interventions have been demonstrated to reduce major morbidity and mortality in premature infants. The degree of underuse of these interventions and the relative magnitude of underuse for minority versus white patients has not been well documented. Furthermore, the extent to which white and non-white premature infants receive care at different hospitals in New York City is unknown. Likewise, whether NICUs differ in practice with respect to effective management of prematurity has not been studied. We propose to use medical record review to assess the underuse of three effective interventions (antenatal corticosteroids, surfactant therapy, and maintenance of body temperature) in the management of prematurity. First, we will use birth certificate data to confirm and expand upon preliminary data from hospital discharge abstracts in showing that black premature infants are more likely than white premature infants to be born at low volume hospitals. We will measure underuse of selected effective interventions at two low volume hospitals serving predominantly women from East and Central Harlem and at a high volume hospital serving East and Central Harlem and at a high volume hospital serving East and Central Harlem as well as a diverse population from other areas of New York City. We will assess whether rates of underuse differ by racial and ethnic groups among hospitals serving predominantly minority versus predominantly white communities, and within the one hospital serving a diverse patient population. Finally, we will investigate the likely causes of underuse of effective interventions that preferentially impact the Black and Hispanic communities of East and Central Harlem.

美国黑人婴儿的死亡率是白色婴儿的两倍多。在上曼哈顿，东部和中部哈莱姆的少数民族社区的婴儿死亡率是上东区白色人为主的社区的四倍。死亡率的这种差异与黑人中早产率较高有关。极低出生体重儿（<1500克）的死亡率是正常出生体重儿的90倍，极低出生体重儿在黑人中的比例是白人的3.5倍。虽然黑人婴儿比白人婴儿早产的可能性大得多，但已证明有几种干预措施可降低早产儿的主要发病率和死亡率。这些干预措施未充分使用的程度以及少数民族与白色患者未充分使用的相对程度尚未得到充分记录。此外，白色和非白色早产儿在纽约市不同医院接受护理的程度尚不清楚。同样，NICU在早产儿有效管理方面的实践是否不同也没有研究。我们建议使用病历审查来评估早产儿管理中三种有效干预措施（产前皮质类固醇、表面活性物质治疗和维持体温）的使用不足。首先，我们将使用出生证明数据来证实和扩展医院出院摘要的初步数据，表明黑人早产儿比白色早产儿更有可能出生在低容量医院。我们将在两个主要服务于东部和中部哈莱姆妇女的低容量医院、一个服务于东部和中部哈莱姆的高容量医院和一个服务于东部和中部哈莱姆以及来自纽约市其他地区的不同人群的高容量医院测量选定有效干预措施的未充分使用。我们将评估服务于主要少数民族社区与主要白色社区的医院之间以及服务于不同患者人群的一家医院内的未充分使用率是否因种族和民族而异。最后，我们将调查未充分利用有效干预措施的可能原因，这些干预措施优先影响东部和中部哈莱姆的黑人和西班牙裔社区。