Race, Ethnicity and Quality of Health Care for Newborns

描述(由申请者提供)：许多研究考察了导致新生儿健康结果的种族和民族差异的因素。一个尚未得到很好研究的问题是新生儿重症监护病房(NICU)的使用情况不同，以及高质量医院的使用情况不同。其他领域(例如心脏护理)的研究证明，在治疗使用和使用高质量提供者方面存在很大的种族和民族差异，这引发了人们对这可能在新生儿结局差异中发挥的作用的质疑。我们将研究使用NICU的种族和民族差异，特别是使用先进和大容量NICU的使用，以及新生儿使用高质量医院的情况，特别是LBW和VLBW新生儿，使用将7个州20世纪90年代大部分时间内所有出生的生命统计和出院数据联系起来的二级数据集。我们对高质量医院使用的分析将基于基于患者结果的新的医院质量衡量标准，我们将使用新的和创新的方法来制定这些标准。我们的主要分析旨在实现3个具体目标：1)调查不同种族和民族在NICU和高容量设施使用方面的差异程度，并检查使用率差异的相关性；2)构建新的基于结果的新生儿医院护理质量指标，检查不同种族和民族的新生儿出生或被转移到的医院质量的差异，并检查差异的相关性；以及3)检查获得NICU、高容量设施和高质量医院的差异对不同种族和民族的新生儿健康结果差异的影响。与以前对新生儿结局差异的大规模分析相比，我们将使用的数据集还提供了更广泛的机会来控制合并症和其他风险因素，并提供了研究地理(“小区域”)差异在新生儿结局差异中所起作用的机会。随着我们对NICU和高质量医院使用的差异进行分析，我们也将把新数据集的这些能力应用到差异研究中，努力实现具体目标4：使用新的关联数据库来扩展关于新生儿健康结果中的种族和民族差异的工作，特别是考虑到新的关联数据集中新获得的共病和其他风险因素的差异，并研究不同地理区域的差异的影响。我们的工作将集中在黑人和白人的差异，拉美裔美国人(包括墨西哥人和波多黎各人)的差异，以及亚洲和太平洋岛民的差异。

DESCRIPTION (provided by applicant): Numerous studies have examined factors that contribute to racial and ethnic disparities in health outcomes for newborns. An issue that has not been well studied is variation in the use of neonatal intensive care units (NICUs) and variation in the use of high quality hospitals. Studies in other areas (e.g. cardiac care) document large racial and ethnic disparities in treatment use and use of high quality providers, raising questions about the role that this might play in newborn outcome disparities as well. We will study racial and ethnic variation in use of NICUs, particularly the use of advanced and high volume NICUs, and use of high quality hospitals by newborns, particularly LBW and VLBW newborns, using secondary datasets that link vital statistics and hospital discharge data for all births in 7 states over most of the 1990s. Our analysis of high quality hospital use will be based on new measures of hospital quality based on patient outcomes that we will develop using new and innovative methods. Our main analysis is designed to achieve 3 specific aims: 1) to investigate the extent of differences in use of NICUs and high volume facilities by race and ethnicity, and examine the correlates of differences in utilization rates; 2) to construct new outcome-based indicators of the quality of hospital care for newborns, and examine variations in the quality of hospitals at which newborns of different races and ethnicities are born or to which they are transferred, and to examine the correlates of differences; and 3) to examine the effect of differences in access to NICUs, high volume facilities, and high quality hospitals on disparities in health outcomes for newborns by race and ethnicity. The datasets we will use also afford more extensive opportunities to control for co-morbidities and other risk factors than have been available in previous large-scale analyses of newborn outcome disparities, as well as presenting the opportunity to study the role played by geographic ("small area") variations in newborn outcome disparities. As we conduct our analysis of disparities in NICU and high quality hospital use, we will also apply these capabilities of the new datasets to the study of disparities, working to achieve specific aim 4: to use the new linked databases to extend work on racial and ethnic disparities in health outcomes for newborns, particularly accounting for variations in co-morbidities and other risk factors, newly available in the new linked datasets, and studying effects of variation across geographic areas. Our work will focus on Black-White differences, disparities for Hispanics (including subgroups like Mexican and Puerto Rican), and disparities for Asian and Pacific Islanders.