Do Obstetrical Quality Measures Explain Racial Disparities in Perinatal Outcomes

描述(由申请者提供)：新生儿和产妇死亡率持续存在的黑人/白人差距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差。尽管每年在保健方面花费数十亿美元，几乎一半的分娩发生在少数族裔妇女身上，但产科保健方面的业绩和质量衡量标准尚未得到彻底检查。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，但很少有研究讨论当前产科质量指标在解释新生儿死亡率和其他孕产妇健康结果，特别是产妇死亡率方面的种族/民族差异的作用。我们建议进行一项研究，调查35种推荐产科质量指标在各医院的可变性，并使用这些指标进行分析，以调查新生儿和产妇死亡率的种族/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产科质量指标来衡量医院之间的可变性；2)确定产科质量指标是否因种族/民族而不同；以及3)检查种族/民族差异是否可以解释孕产妇和新生儿死亡率中种族/民族差异的差异。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)和西奈山数据库(电子病历)来调查指定医院之间产科质量指标的差异。我们还将使用人口普查局的社区社会经济状况变量数据和AMA的医院特征数据。我们将使用联合委员会和其他国家质量领导机构确定的衡量这些质量指标所需的具体数据要素。还将评估质量指标与社会经济状况和临床风险因素之间的关系，以确定哪些指标最容易产生偏差。最后，我们将进行分析，以检查产科质量是否因种族/民族而不同，以及这种差异是否解释了产妇和极低出生体重新生儿死亡率的种族/民族差异。这项研究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程序，以减少未来与产科相关的结果中的种族/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.