Do Obstetrical Quality Measures Explain Racial Disparities in Perinatal Outcomes

描述（由申请人提供）：黑人/白人在新生儿和孕产妇死亡率方面的持续差异是一个主要的公共卫生问题，与其他国家相比，美国在这些指标上的排名仍然很低。尽管每年在医疗保健方面花费数十亿美元，少数民族妇女几乎占所有分娩的一半，但产科护理的绩效和质量措施尚未得到彻底审查。虽然医院质量与新生儿极低出生体重（VLBW）死亡率和产科结果有关，但很少有研究涉及当前产科质量措施在解释新生儿死亡率和其他孕产妇健康结果，特别是孕产妇死亡率方面的种族/民族差异方面的作用。我们建议进行一项研究，以调查35种推荐的产科质量措施在各医院之间的可变性，并利用这些措施进行分析，以调查新生儿和孕产妇死亡率的种族/民族差异。我们的目标是：1)在常规数据来源中试点使用当前的产科质量指标来衡量医院之间的差异；2)确定产科质量措施是否因种族/民族而异；3)检查种族/民族差异是否解释了孕产妇和新生儿死亡率的种族/民族差异。方法：我们将使用国家住院患者样本（NIS）、纽约州出院摘要数据（SPARCS）和西奈山仓库（电子病历）来调查指定医院产科质量指标的差异。我们还将使用人口普查局的数据作为社区社会经济地位变量，并使用美国医学协会的数据作为医院特征。我们将使用由联合委员会和其他国家质量领导定义的测量这些质量指标所需的具体数据元素。还将评估质量指标与社会经济地位和临床风险因素之间的关系，以确定最容易产生偏差的指标。最后，我们将进行分析，以检查产科质量是否因种族/民族而异，以及这种差异是否解释了孕产妇和VLBW新生儿死亡率的种族/民族差异。本研究提供的信息将更好地了解医院新生儿和产妇护理的质量，并揭示可以改进的具体护理过程，以减少未来产科相关结果中的种族/民族差异。

DESCRIPTION (provided by applicant): Persistent Black/White disparities in neonatal and maternal mortality rates are a major public health concern and the United States continues to rank poorly on these measures when compared to other nations. Despite billions of dollars spent in health care annually and nearly half of all births occurring to minority women, performance and quality measures in obstetrical care have yet to be thoroughly examined. Although hospital quality has been associated with neonatal very low birth weight (VLBW) mortality and obstetrical outcomes, little research has addressed the role of current obstetrical quality measures in explaining racial/ethnic disparities in neonatal mortality and other maternal health outcomes, specifically maternal mortality. We propose a study to investigate variability of 35 recommended obstetrical quality measures across hospitals and to conduct analyses using these measures to investigate racial/ethnic disparities in neonatal and maternal mortality rates. Our objectives are to: 1) Pilot the use of current obstetrical quality indicators in routine data sources to measure variability across hospitals; 2) determine whether obstetrical quality measures differ by race/ethnicity and 3) examine whether racial/ethnic differences explain variation in racial/ethnic disparities in maternal and neonatal mortality rates. Methods: We will use the National Inpatient Sample (NIS), New York State Discharge Abstract Data (SPARCS), and the Mount Sinai Warehouse (electronic medical records) to investigate variation in obstetrical quality indicators among designated hospitals. We will also use Census Bureau data for community socio-economic status variables and AMA data for hospital characteristics. We will use the specific data elements required for measurement of these quality indicators as defined by the Joint Commission and other national quality leaders. The relationship between quality indicators and socio-economic status and clinical risk factors will also be assessed in order to identify those indicators most susceptible to bias. Lastly, we will conduct analyses to examine whether obstetrical quality differs by race/ethnicity, and whether such differences explain racial/ethnic disparities in maternal and VLBW neonatal mortality rates. Information from this study will provide a better understanding of quality in neonatal and maternity care in hospitals and reveal specific processes of care that could be improved upon to reduce racial/ethnic disparities in obstetrical-related outcomes in the future. PUBLIC HEALTH RELEVANCE: Black/White disparities in neonatal and maternal mortality rates are a major public health concern in the United States yet the little research has addressed the role of current obstetrical quality measures in explaining these racial/ethnic disparities. Data from the proposed study will describe the variability of current obstetrical quality indicators across hospitals, determine differences in obstetrical quality measures by race/ethnicity and identify the role of obstetrical quality measures in explaining disparities in neonatal and maternal mortality. Findings could inform recommendations regarding the feasibility of using routine data sources to construct obstetrical quality measures, increase our understanding of the quality of obstetrical care in hospitals and ultimately, identify opportunities for reducing persistent racial/ethnic disparities in maternal and neonatal mortality.