Disparities in Processes and Outcomes of Care Across Asian/Pacific Islander Populations at Childbirth

亚洲/太平洋岛民分娩护理过程和结果的差异

• 批准号: 10667578
• 负责人: Elliott K Main
• 金额: $ 66.18万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10667578
• 关键词: Accounting; Acculturation; Address; Affect; Area; Asian; Asian Americans; Asian population; Attention; Benchmarking; Biological; Birth; Birth Rate; Black Populations; California; Caring; Cesarean section; Cessation of life; Childbirth; Chinese; Clinical; Collaborations; Communities; Country; Data; Data Set; Data Sources; Disparity; Epidemiology; Episiotomy; Equity; Ethnic Origin; Ethnic Population; Filipino; Future; Geography; Health; Heterogeneity; Hispanic Populations; Hospitalization; Hospitals; Human Milk; Immigration; Individual; Infant; Infant Care; Infant Mortality; Infrastructure; Interview; Japanese; Joints; Knowledge; Laceration; Link; Literature; Maternity Hospitals; Measures; Medical; Methods; Monitor; Morbidity - disease rate; Mothers; National Health Policy; Neighborhoods; Neonatal Intensive Care Units; Newborn Infant; Nosocomial Infections; Not Hispanic or Latino; Nulliparity; Outcome; Pacific Islander; Parents; Patients; Performance; Perinatal; Persons; Policies; Population; Positioning Attribute; Process; Provider; Quality of Care; Race; Recording of previous events; Reporting; Research; Research Personnel; Risk; Risk Factors; Sampling; Small for Gestational Age Infant; Socioeconomic Status; Structure; Subgroup; Surveys; Testing; Translating; United States; Variant; Very Low Birth Weight Infant; Vietnamese; Vulnerable Populations; Work; breastfed newborn; care delivery; care outcomes; comparative; data resource; design; disparity reduction; ethnic disparity; experience; health care disparity; high risk population; hospital care; hospital performance; improved; innovation; insight; member; mortality; multidisciplinary; policy recommendation; population based; quality improvement organization; racial disparity; racial population; segregation; severe maternal morbidity; social; social culture; sociodemographics; success

Racial/ethnic disparities in the quality of care provided to mothers and infants during the birth hospitalizations result directly in avoidable death and morbidity. Asian American and Pacific Islanders (AAPI) represent the fastest growing racial/ethnic group (25% living in California) and they experience significant disparities in several areas that are robust and merit policy and clinical attention. Unfortunately, research of AAPI populations suffers considerable limitations. First, few studies report on AAPI populations and those that do, usually aggregate to “Asian” or “Asian American and Pacific Islander”, masking the biological and sociocultural heterogeneity. Sec- ond, sociodemographic and neighborhood factors are rarely available for studies of hospital quality at childbirth. Third, lack of multilevel adjustment undermines the validity of comparative assessments of quality by penalizing hospitals that care for vulnerable populations. To understand disparities in care processes and outcomes for AAPI mother/infants, we will undertake a compre- hensive appraisal of the multilevel factors associated with quality of care during the birth hospitalization, promote fairer comparisons by making sociodemographic and neighborhood influences explicit; and assess key areas of quality using key performance metrics for care provided to mothers, low-risk newborns, and infants born very low-birth-weight (VLBW; <1500g). Innovative methods include leveraging our unique multilevel data sources to provide comprehensive assess- ments of hospital quality for AAPI populations with unprecedented granularity, assessing quality via key indi- vidual and composite measures, and using a mixed-methods approach to provide unique insights into the mechanisms by which sociocultural and neighborhood factors optimize or degrade quality. Specific aims: 1) Test for disparities in care processes and outcomes among AAPI mothers and infants and identify associations with patient and neighborhood level social risk factors; 2) Assess the impact of hospital performance on care processes and outcomes of AAPI maternal/infant popula- tions; and 3) Understand the birth and birth hospitalization experiences of AAPI populations alongside drivers of disparities in care processes and outcomes. An exceptional strength of our proposal is our ability to leverage the unique infrastructure of the California Peri- natal and Maternal Quality Care Collaboratives. Building on our prior work in linking complimentary high-quality clinical, administrative, and survey-based data sets containing multi-level factors, we will study a large popula- tion-scale AAPI sample of 1.6 million mothers and newborns (including ~8,000 VLBW infants) in 238 maternity hospitals and 138 neonatal intensive care units in California between 2011-23. Results of this proposal are expected to have an immediate positive impact because in leveraging our expertise as active quality improve- ment organizations, they are designed to identify pragmatic areas where hospitals and communities can improve.

在分娩住院期间为母亲和婴儿提供的护理质量方面的种族/族裔差异 直接导致可避免的死亡和发病。亚裔美国人和太平洋岛民(AAPI)代表 增长最快的种族/民族群体(25%生活在加利福尼亚州)，他们在几个方面经历了显著的差异 稳健且值得政策和临床关注的领域。不幸的是，对AAPI种群的研究受到了影响 有相当大的局限性。首先，很少有关于AAPI种群和那些有AAPI种群的研究报告，通常汇总到 “亚洲人”或“亚裔美国人和太平洋岛民”，掩盖了生物和社会文化的异质性。SEC- 其次，社会人口学和邻里因素很少用于分娩时医院质量的研究。 第三，缺乏多层次的调整，通过惩罚损害了质量比较评估的有效性 照顾弱势群体的医院。 为了了解AAPI母婴护理过程和结果的差异，我们将进行一项综合调查 出生住院期间影响护理质量的多层次因素的综合评价 通过明确社会人口和社区影响进行更公平的比较；并评估以下关键领域 使用为母亲、低风险新生儿和新生儿提供护理的关键绩效指标的质量 低出生体重(VLBW；&lt；1500克)。 创新方法包括利用我们独特的多层次数据源提供全面的评估- 以前所未有的粒度对AAPI人群进行医院质量评价，通过关键指标进行质量评估 视觉和复合措施，并使用混合方法方法来提供对 社会文化和社区因素优化或降低质量的机制。具体目标： 1)测试AAPI母亲和婴儿在护理过程和结果方面的差异，并确定相关关系 有耐心和邻里层面的社会风险因素； 2)评估医院绩效对AAPI母婴人群护理过程和结果的影响- 选段；以及 3)了解AAPI人群的分娩和分娩住院经历以及差异的驱动因素 在护理过程和结果方面。 我们提案的一个特殊优势是我们有能力利用加州周边地区独特的基础设施- 产后和产妇质量护理协作。在我们之前工作的基础上，链接免费的高质量 临床、管理和基于调查的数据集包含多层次因素，我们将研究大量人群- 对238名孕妇中的160万名母亲和新生儿(包括约8000名极低出生体重婴儿)进行了AAPI量表抽样调查 2011-23年间，加利福尼亚州的医院和138个新生儿重症监护病房。这项建议的结果是 预计将立即产生积极影响，因为在利用我们的专业知识作为积极的质量改进- 作为医疗组织的一部分，它们旨在确定医院和社区可以改进的务实领域。