Pathways to Reduce Infant Deaths

减少婴儿死亡的途径

• 批准号: 8823453
• 负责人: Elizabeth A Howell
• 金额: $ 42.97万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8823453
• 关键词: Accounting; Adrenal Cortex Hormones; Birth; Caring; Characteristics; Clinical; Communication; Communities; Data; Decision Making; Discipline of obstetrics; Ethnic Origin; Evidence based practice; Expenditure; Future; Geography; Health; Hospital Mortality; Hospitals; Infant; Infant Mortality; Intervention; Knowledge; Latino; Leadership; Link; Literature; Location; Measures; Methods; Minority; Modeling; Morbidity - disease rate; Mothers; Neonatal; Neonatal Mortality; New York; New York City; Nurseries; Nurses; Outcome; Pathway interactions; Patients; Pattern; Performance; Phase; Physicians; Premature Infant; Process; Public Health; Qualitative Methods; Quality of Care; Race; Records; Replacement Therapy; Research; Risk; Urban Hospitals; Variant; Very Low Birth Weight Infant; Vital Statistics; Weight; Woman; Work; abstracting; base; evidence base; high risk; improved; infant death; innovation; mortality; neonatal care; neonatal death; neonate; patient oriented; perinatal outcomes; prevent; public health relevance; racial and ethnic disparities; racial disparity; risk perception; statistics; surfactant; uptake

DESCRIPTION (provided by applicant): Persistent racial disparities in neonatal mortality rates are a major public health concern. Black neonates are more than twice as likely to die as white neonates. In previous research in New York City (NYC) hospitals, we found nearly a three-fold variation in risk-adjusted very low birth weight (VLBW) neonatal mortality rates among hospitals and black infants were much more likely to be born at higher mortality hospitals. The factors that influence wide variation in mortality rates among hospitals are not known. Why black women are more likely to deliver at higher mortality hospitals is also unknown. The objectives of this study are: 1) To examine risk- adjusted neonatal mortality among New York City hospitals over the past decade and assess the extent to which variations in hospital quality contribute to VLBW mortality disparities for blacks and Latinos; 2) To use an innovative mixed methods approach to explore processes of care, unit characteristics, patient factors, and organizational factors that explain differences in hospital quality as measured by overall and cause-specific risk-adjusted mortality rates and use of evidence-based practices; 3) To explore patients' perspectives on barriers to receipt of high quality care by exploring barriers to timely care, communication, availability of high risk obstetrics care, knowledge, decision-making regarding delivery hospital, and perception of risk; and 4) To create specific strategies with key stakeholders to promote uptake of best practices at hospitals caring for VLBW infants including patient-centered strategies to minimize barriers to receipt of high quality care. Methods: In Phase 1, we will use NYC Vital Statistics records linked with New York State Discharge Abstract Data to develop a risk-adjusted VLBW neonatal mortality model. We will use this model to rank hospitals based on risk-adjusted mortality. We will then examine the distribution of black, Latino, and white births among hospitals. In Phases 2 and 3 we will use both quantitative and qualitative methods to determine which hospital factors and practice patterns may explain the wide variation in mortality outcomes among hospitals and to explore why black mothers deliver in higher mortality hospitals. We will then convene leaders of obstetrics and neonatologists, hospital quality leaders, community leaders, NYC and State Departments of Health, and patients to discuss our results and explore interventions to improve care for VLBW infants. Information from this study will provide a better understanding of quality in neonatal care in hospitals and reveal specific processes of care that can be improved upon to reduce racial/ethnic disparities in neonatal outcomes.

描述（由申请人提供）：新生儿死亡率的持续种族差异是一个主要的公共卫生问题。黑人新生儿的死亡率是白人新生儿的两倍多。在纽约市（NYC）医院的先前研究中，我们发现医院中风险调整过低出生体重（VLBW）新生儿死亡率的差异接近三倍，黑人婴儿更有可能出生在死亡率较高的医院。影响各医院死亡率差异巨大的因素尚不清楚。为什么黑人妇女更有可能在死亡率更高的医院分娩也是未知的。本研究的目的是：1)检查过去十年纽约市医院中经风险调整的新生儿死亡率，并评估医院质量的变化对黑人和拉丁裔婴儿死亡率差异的影响程度；2)使用一种创新的混合方法方法来探索解释医院质量差异的护理过程、单位特征、患者因素和组织因素，这些差异由总体和特定原因的风险调整死亡率和循证实践的使用来衡量；3)通过探讨及时护理障碍、沟通障碍、高危产科护理的可获得性障碍、知识障碍、分娩医院决策障碍和风险感知障碍，探讨患者对接受高质量护理障碍的看法；4)与主要利益攸关方一起制定具体战略，促进在照顾超低体重婴儿的医院采用最佳做法，包括以患者为中心的战略，以尽量减少接受高质量护理的障碍。方法：在第一阶段，我们将使用纽约市生命统计记录与纽约州出院摘要数据相关联，以建立风险调整的VLBW新生儿死亡率模型。我们将使用该模型根据风险调整死亡率对医院进行排名。然后，我们将检查医院中黑人、拉丁裔和白人出生的分布。在第二和第三阶段，我们将使用定量和定性方法来确定哪些医院因素和实践模式可以解释医院之间死亡率结果的广泛差异，并探讨为什么黑人母亲在死亡率较高的医院分娩。然后，我们将召集产科和新生儿专家、医院质量领导、社区领导、纽约市和州卫生部门以及患者讨论我们的结果，并探讨改善对VLBW婴儿护理的干预措施。本研究提供的信息将更好地了解医院新生儿护理的质量，并揭示可以改进的具体护理过程，以减少新生儿结局的种族/民族差异。