A Dashboard of Racial/Ethnic Disparity in Care Provided by NICUs

 描述（由申请人提供）：几项研究表明，新生儿重症监护室（NICU）为极低出生体重（VLBW; 1500 g）婴儿提供的护理质量存在种族和民族差异。然而，没有对这个问题进行常规的全面评估，剥夺了医疗保健提供者的改进路线图。有关质量的信息反馈已成功地用于改善极低出生体重婴儿的护理和结局，并可用于减少或消除结局的差异。因此，我们建议研究NICU为VLBW婴儿提供的护理质量的种族和民族差异，并将我们的研究结果转化为基于网络的实时差异仪表板。利用独特的现有资源和其他地方没有的相关数据集，我们提供了一个前所未有的机会来解决这个高度优先的主题。我们提出了一项大型人群规模的观察性研究，以分析2008年至2018年从加州围产期质量护理合作组织或佛蒙特州牛津网络成员的700多个NICU中收集的约350，000名VLBW婴儿的常规数据。这些新生儿重症监护室加在一起覆盖了美国85%的极低出生体重婴儿住院治疗。我们的分析将使用婴儿监护仪，这是我们在以前的工作中开发的一种新颖，有效和可靠的NICU质量综合衡量标准，以及它的九个子组件，它们共同涵盖了整个分娩住院期间的护理质量。我们使用复合材料及其子组件的理由是，全面的测量将促进全面的改进。本研究旨在实现3个具体目标：1）确定NICU内和NICU之间提供的护理质量的种族/民族差异和影响因素; 2）根据NICU内的婴儿监护仪子组件确定种族/民族差异特征; 3）制定NICU护理质量的种族/民族差异基准报告。我们将使用的数据集提供了更广泛的机会来控制合并症，社会和组织风险因素，而不是在以前的大规模新生儿结局差异分析中，提供了研究邻里水平因素在VLBW护理质量中所起作用的机会。我们的工作将集中在黑人和白人的差异，西班牙裔的差异，以及亚洲和太平洋岛民的差异。当我们对NICU护理服务质量的差异进行分析时，我们还将通过采用贝叶斯纵向和前瞻性方法来推进质量改进科学，这些方法允许NICU提供者评估和预测护理服务的差异。

 DESCRIPTION (provided by applicant): Several studies have shown racial and ethnic disparities in the quality of care provided by neonatal intensive care units (NICUs) to very low-birth-weight (VLBW; 1500g) infants. However, no routine comprehensive assessment of this problem exists, depriving health care providers of a roadmap to improvement. Feedback of information about quality has been used successfully to improve care and outcomes for VLBW infants and may be applied to reduce or eliminate disparity in outcomes. We therefore propose to study racial and ethnic differences in quality of care provided by NICUs to VLBW infants and to translate our findings into a web-based real-time disparity dashboard. Employing unique existing resources and linked data sets not available elsewhere, we submit an unprecedented opportunity to address this high-priority topic. We propose a large population-scale observational study to analyze routinely collected data from 2008 to 2018 from ~350,000 VLBW infants in more than 700 NICUs that are members of the California Perinatal Quality Care Collaborative or the Vermont Oxford Network. Together, these NICUs cover 85 percent of the VLBW infant birth hospitalizations in the US. Our analysis will use the Baby-MONITOR, a novel, valid and reliable composite measure of NICU quality developed by us in prior work, and its nine subcomponents, which together span quality of care delivery throughout the birth hospitalization. Our rationale for using the composite and its subcomponents is that comprehensive measurement will promote comprehensive improvement. This study is designed to achieve 3 specific aims: 1) Identify racial/ethnic differences and contributing factors in the quality of care provided within and between NICUs; 2) Identify racial/ethnic disparity profiles based on Baby-MONITOR sub-components within NICUs; and 3) Develop benchmarking reports of racial/ethnic disparity in quality of care delivery for NICUs. The datasets we will use afford more extensive opportunities to control for co-morbidities, social, and organizational risk factors than have been available in previous large-scale analyses of newborn outcome disparities, presenting the opportunity to study the role played by neighborhood level factors in VLBW quality of care delivery. Our work will focus on Black-White differences, disparities for Hispanics, and disparities for Asian and Pacific Islanders. As we conduct our analysis of disparities in NICU quality of care delivery, we will also advance the science of quality improvement by employing Bayesian longitudinal and prospective methodologies that allow NICU providers to assess and forecast disparities in care delivery.